经导管射频消融治疗局灶性心房颤动

Radiofrequency Catheter Ablation of Focal Atrial Fibrillation

报道19例局灶性心房颤动（简称房颤）射频消融治疗的结果，其中药物治疗无效且发作频繁（＞1次／日）的阵发性房颤17例、慢性房颤2例。17例患者尚同时合并有频发房性早搏（简称房早）（动态心电图显示＞700个／日）。同步记录高位有房、冠状静脉窦及左、右上肺静脉电图。根据房早或房颤开始发作时的心房激动顺序确定异位兴奋灶部位，以局部双极电图较体表心电图P'波起点最提前处为消融靶点。成功标准为消融后6Omin内房早／房颤消失及随访期内可以无须药物而维持窦性心律。结果：92．6％（25／27）的异位兴奋灶位于肺静脉，其中尤以双上肺静脉居多（21／25）。随访2．4±3．7个月后有13例患者（68．4％）达上述成功标准，其房早数目由术前的3720±2741个／日降至216±139个／日，除1例发生心房穿孔外无其他严重并发症。结论：射频消融治疗局灶性房颤效果较好，可以作为药物治疗无效的阵发性房颤患者的治疗选择。

We reported the results of radiofrequency catheter ablation in 19 patients with focal atrial fibrillation (AF),including 17 with frequent episodes (at least one episode per day) of drug-refractory paroxysmal AF and two chronic AF. In 17 patients,frequent isolated atrial ectopics beats (more than 700 per 24 hour) were documented in the Holter record. High right atrium,coronary sinus and right and left superior pulmonary vein were mapped slmultaneously. A focal source of activation was confirmed by a consistent and centrifugal pattern of activation during the atrial premature beats or initiation of AF, Radiofrequency ablation was performed at the site of earliest bipolar activity relative to the onset of ectopic P wave. Successful ablation was defined as the elimination of atriaI premature beats/AF during the 60 min after ablation and without AF recurrence during the follow-up period. Results: Most of the ectopic foci (92. 6% ) were observed in pulmonary veins,especially in superior pumonary veins. During the follow up period of 2. 4±3. 7 months, 13 patients (68. 4% ) were free of symptomatic AF without antiarrhythmic drugs. In these patients, the numbers of atrial premature beats decreased significantly after procedure (3720±2741vs 216±139 beats/day ). There were no major complications except for one cardiac perforation. lt is suggested that radiofrequency catheter ablatlon ls a highly effective treatment for focal AF and can be offered to drug-refractory paroxysmal AF as an alternative therapy.