阵发性心房扑动-心房颤动电生理检查和射频消融治疗

Electrophysiological properties and the effect of ablation on paroxysmal atrial flutter-fibrillation patients

目的 对经选择的阵发性心房扑动 心房颤动患者 (AFFL) ,在三尖瓣环 下腔静脉峡部(RAIS)进行射频消融 ,探讨这类房性快速心律的电生理特点和治疗效果。方法 10例频繁发作AFFL患者与同期 10例I型心房扑动 (AF) ,经心内电生理检查并按解剖部位进行RAIS线性消融。结果 右房上及冠状静脉窦口有效不应期 ,在AFFL中均短于AF ,房内传导时间亦较AF为延长。AFFL中 6例在窦性心律 (窦律 )下消融 ,及 2 / 4例在发作时消融均即刻不再诱发 ,另 2 / 4例术后 2 4小时恢复窦律 ,近期效果 10 0 %。随诊 3～ 3 6个月 (均 18 6± 14 2月 ) 3例 (3 0 % )仍保持窦律 ,半年内共 9例 (90 % )维持窦律 ,1例死于肺癌。半年后 6例复发 ,次数及持续时间明显减少 ,并可被原无效药物控制。结论 AFFL可能是AF到心房颤动中间的一种类型 ,RAIS在此类型中发生重要作用。有必要对心房颤动进行细致分类以便选择针对性的治疗措施。

Objective To test the occurrence of atrial flutter atrial fibrillation (AFFL) in at least some patients is based on macro reentry around right atrium tricuspid valve orifice, including tricuspid IVC isthmus (RAIS), and to evaluate the effect of radiofrequency ablation (RFCA) of AFFL on RAIS. Methods and Results Ten drug resistant paroxysmal AFFL patients together with 10 atrial flutter (AF) patients underwent EPS and RFCA on the RAIS. The ERP of HRA and CSO were shorter, and with longer inter atrial conduction time in AFFL than in AF. Right atrial AF and left atrial “organized atrial fibrillation” revealed in all AFFL patients. AF and fibrillation were coexisting and alternating during the test. Follow up for 3 36 (average 18 6±14 2) months after ablation, 3 (30%) cases remained in sinus rhythm, the other 6 cases remained in sinus rhythm on average 5 8±3 7 months, therefore during an average of 6 months, 90% cases were in sinus rhythm. 6 cases recurred after an average of 6 months, but paroxysms were significantly reduced or could be controlled by originally ineffective drugs. Conclusion The effect of RFCA on AFFL suggests that AFFL might be an intermediate stage between AF and fibrillation. RAIS may play an important role in the initiation or maintenance of this type of arrhythmia. Further classifications of atrial fibrillation are in necessity for selection of indicated patients for ablation.