心房颤动患者初次射频导管消融后复发病例分析及再消融

An Analysis of Cases with Recurrent Atrial Fibrillation after First Radiofrequency Ablation and Re-ablation

目的 分析心房颤动射频导管消融（下标消融）后复发患者电生理检查结果及再消融治疗,探讨其复发机制. 方法 入选30例心房颤动初次消融后复发病例,在Carto三维标测系统指导下,通过检查肺静脉、辅助线等电传导恢复情况,明确复发心动过速的机制,并进行相应消融. 结果 30例患者中.25例肺静脉恢复传导,18例术中转归为大折返性心动过速,13例标测到肺静脉外异位兴奋灶.3例行再次环肺静脉电隔离术,余27例附加线性消融和（或）碎裂电位消融.结论 肺静脉传导恢复是术后复发的主要因素,此外肺静脉外起源、消融线未完全阻滞等也是心房颤动消融术后复发的重要因素.

Objective To investigate the mechanisms of atrial fibrillation （AF） recurrence after first ablation and perform repeat ablation. Methods The conduction characteristics of pulmonary veins and linear ablation lesions was determined by electrephysiological test and then proper ablation was performed under guidance of Carto system in 30 patients with recurrent AF. Results Recovered pulmonary vein conduction was seen in 25 patients. Maero-reentrant taehycardia occurred before or during the test in 18 patients. An ectopic discharging focus beyond pulmonary veins was identified in 13 patients. Circumferential pulmonary vein ablation was performed in 3 patients and linear ablation and/or fragmented potentials ablation in 27 patients. Conclusion Recovered pulmonary vein conduction is a dominant factor of recurrent AF. An ectopic focus beyond pulmonary vein and discontinuities within linear ablation lesions also contribute to AF recurrence.