双腔起搏器术后阵发性心房颤动患者导管消融治疗的安全性及疗效

Safety and effectiveness of radiofrequency catheter ablation on paroxysmal atrial fibrillation patients implanted with double chamber pacemaker

目的评价病窦综合征双腔起搏器术后心房颤动(简称房颤)射频消融治疗的安全性和有效性。方法 12例因病窦综合征行双腔起搏器植入的患者,均伴发房性心动过速(简称房速)、心房扑动(简称房扑)和阵发性房颤,且药物疗效差。行CARTO标测系统指导下的环双肺静脉电隔离术或伴辅助线消融术。术前,术后1周、1个月、3个月观察24h动态心电图和心脏超声。检测手术前后各起搏参数。结果术后房速、房扑、房颤阵数和房颤发作持续时间,心室起搏比率、模式转换次数于术后1周与术前相比明显减少(P<0.05);这种变化持续至术后3个月。术后1周与术前相比左房前后径(LAD)无变化;左房最小容积增大,左房射血分数(LAEF)减少(P<0.05);但术后1个月与术前相比,LAD及左房容积减少,LAEF增加(P<0.05);术后3个月与术后1个月相比LAD、左房容积有进一步减小,LAEF进一步增加(P<0.05)。手术前后心房和心室起搏阈值、导线阻抗、感知阈值等参数无变化。结论 CARTO标测系统指导下的环双肺静脉电隔离术可使双腔起搏器置入术后患者房性心律失常的发生明显减少,心房功能改善,且安全可靠。

Objective To investigate the safety and efficay of radiofrequency catheter ablation on paroxysmal atrial fibrillation patients implanted with double chamber pacemaker Methods Twelve sick sinus syndrome （SSS） patients with double chamber pacemaker were enrolled. All patients were concomitant with atrial tachycardia（AT） , atrial flutter （AFL） , atrial fibrillation（AF） and less effective to drugs. Circumferential pulmonary vein ablations （CPVA） with supplementary line ablation in necessity were done . Echocardiography and Hoher were analysed before and one week, one month,three months after operation. The changes in sensing thresholdand pacing threshold, lead impedance by interrogating before and after ablation were evaluated. Results The frequency of AT,AFL and AF attack, ventricular pacing rate,mode switch times decreased remarkabely one week after operation compared with that of before operation（ P 〈 0.05 ）. The changes sustained till to three months after operation. There was no remarkable change in left atrial diameter（LAD） one week after operation compared with that of before operation but left atrial mini-volume （LAVmin） increased remarkablely （ P 〈0. 05 ） , left atrial ejection fraction （LAEF） decreased remarkablely （ P 〈 0.05 ）. LAD and LAV decreased remarkablely （ P 〈 0. 05 ） , LAEF inereased remarkablely （ P 〈 0. 05 ） one month after opetation compared with that of before operation. LAD and LAV decreased signifieantly（P 〈 0. 05 ） , LAEF increased much more （P 〈 0. 05 ） at three months after opetation compared with that of one month after opetation. There were no changes in sensing and pacing threshold, lead impedance by interro- gating before and after ablation. Conclusion CPVA guided by CARTO system can decrease atrial arrhythmia and improve left atril function in patients with pacemaker who have AT, AFL, AF frequently.