环肺静脉电隔离术后心房-肺静脉电位恢复情况的随访

Distribution of recovery of electrical connections between the pulmonary veins and the left atrium after circumferential pulmonary vein isolation

目的明确环肺静脉电隔离术的长期效果以及心房-肺静脉电位传导恢复的具体部位,以提高手术成功率,预防复发。方法 232例再次行心房颤动(简称房颤)射频消融的患者,采用Lasso环状电极标测,明确其心房-肺静脉电位恢复部位,并在CARTOTM系统指导下予以消融。结果 232例第2次手术病例术中标测示44例(19.0%)无心房-肺静脉电位传导恢复,且术中心房-肺静脉电位传导恢复的部位多存在于左肺静脉前上部65例(28%)、前下部49例(21.1%)、右肺静脉后上部59例(25.4%)及后下部61例(26.3%)。28例行第3次手术,术中标测示无心房-肺静脉电位传导恢复的有16例(57.1%)。5例第4次手术术中标测仅有1例左下肺静脉电位恢复。结论环肺静脉隔离术后,随着随访时间延长肺静脉电位传导有恢复的趋势,并且心房-肺静脉电位传导存在易恢复区,多集中于左肺静脉前上部、前下部、右肺静脉后上部及后下部。部分心房-肺静脉电位传导经多次手术可达完全隔离。

Objective To investigate the prevalence of pulmonary vein （PV）conduction recovery during the following time after circumferential pulmonary vein isolation（CPVI） and explore the distribution of PV re-connections. Methods Two hundred and thirty-two cases with paroxysmal or persistent AF were enrolled for re-ablation. CARTOTM-guided CPVI was performed in all cases with one circular catheter for verification of PVs isolation. Results 232 cases underwent 2 procedures, from which no PV re-connections was identified in 44 （19.0%）cases, meanwhile, PV re-connections were most commonly situated at the left pulmonary antero-superior segment 65 （28%）, left pulmonary antero-inferior segment 49 （21. 1% ） ,right pulmonary postero-superior segment 59 （25.4%）, right pulmonary postero-inferior segment 61 （26.3%）. 28 cases underwent 3 procedures and no PV re-connections was observed in 16（57.1% ）cases. 5 cases underwent d procedures and only one PV re-connections was observed in left pulmonary antero-inferior segment. Conclusion Electrical connections between the pulmonary veins and the left atrium have recovery tendency with the following time going after CPVI. PV re-connections are most commonly situated at the left pulmonary antero-superior , antero-inferior segment, right pulmonary the postero-superior , postero-inferior segment. Part PVs could be isolated completely after several procedures. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2010 ,24 （4） ： 329 - 332 ]