经导管线性消融治疗长程持续性房颤

Treatment of long-standing persistent atrial fibrillation by linear ablation

目的探讨长程持续性房颤导管消融的可行性和疗效。方法 35例长程持续性房颤采用经导管射频消融治疗,术中完成环肺静脉前庭消融、左房顶部线、二尖瓣峡部消融和三尖瓣峡部消融,如未恢复窦性心律,采用直流同步电复律转复窦性心律,然后验证并实现双侧肺静脉电隔离及消融线阻滞。观察即刻消融效果及随访期间房颤复发情况。结果 2例患者消融中转复窦性心律,其余患者电复律恢复窦性心律;所有患者均实现双侧肺静脉电隔离,起搏下验证左房顶部线、二尖瓣峡部线和三尖瓣峡部线取得阻滞的比例分别为100%、88.6%和91.4%。随访期间6(17.1%)例复发。结论采用环肺静脉消融辅以线性消融治疗长程持续性房颤能够较有效地预防房颤复发,减少消融时间。

Objective To explore the feasibility and efficacy of linear ablation in treatment of long-standing persistent atrial fibrillation.Methods Thirty five patients with long-standing persistent atrial fibrillation were undergone catheter ablation,of which circumferential pulmonary vein ablation,roof line ablation,mitral isthmus ablation and tricuspid isthmus ablation were completed.If sinus rhythm was not restored,electrical cardioversion was performed and electrical isolation of pulmonary vein to atrium bilaterically and bidirectional conduction block was examined.To observe the acute ablation efficacy and the recurrence of atrial fibrillation during follow up.Results Two patients achieve sinus rhythm during ablation,while others restored sinus rhythm through cadioversion.All patients achieved electrical isolation of pulmonary vein to atrium bilaterically.The percentage of conduction block for roof line,mitral isthmus and tricuspid isthmus were 100%,88.6% and 91.4% respectively.Six（17.1%） patients had recurrence episodes during follow up.Conclusions Linear ablation and circumferential pulmonary vein ablation for long-standing persistent atrial fibrillation is feasibility with less operation time.