点消融治疗起源于肺静脉的局灶性心房颤动(附一例报告)

Focal Atrial Fibrillation Treated by Discrete Radiofrequency Ablation:One Case Report

报道 1例成功消融的局灶性心房颤动 (简称房颤 )。男性、5 3岁 ,有阵发性心悸病史 3年。诊断为特发性房颤。多次 2 4 h心电图发现有频发房性早搏 (简称房早 )及反复发作的短暂房颤 ,房颤由房早发动 ,自动终止。放置 6F多极导管电极于右室、His束及冠状静脉窦 (CS) ,Halo电极置于右房。普通温控 4 mm可操纵大头消融电极经房间隔穿刺鞘管送入左房。在左上肺静脉入口 10 mm内标测到最提前的电位 ,比体表心电图房早的 P 波明显提前 60 ms。采用温控法 (5 5～ 60℃ )放电 2次 ,消融成功。随诊 3个月 ,无并发症 ;未服用抗心律失常药物 ,无房颤发作。结论 :点消融是治疗起源于肺静脉房颤的安全有效方法。

One male patient,53 years old,had the history of paroxysmal palpitation for 3 years.His clinical diagnosis was idiopathic atrial fibrillation (AF).There were recurrent atrial premature beat (APB) and AF on the record of Holter electrocardiogram.AF was provoked by APB.6F multiple electrode catheters were placed at right ventricle,His bundle,coronary sinus,right atrium.4 mm large tipped controllable ablating electrode was put into left atrium through penetrated interatrial septum.Result:The earliest local potential was mapped 10 mm inside the left superior pulmonary vein,which was 60 ms ahead the P of APB on body surface electrocardiogram.Radiofrequency energy was discharged between the large tip and the patch under the patients back.The temperature during discharge was between 55℃-60℃.After the target site was successfully ablated,AF could not be provoked.No AF recurred during 3 months follow up.Conclusion:The focal AF originating from pulmonary vein could be eliminated by discrete radiofrequency ablation with great efficacy and safety.