经导管消融治疗心房颤动伴心动过缓

Transcatheter radiofrequency ablation for treatment of atrial fibrillation and bradycardia

目的探讨经导管消融治疗心房颤动合并心动过缓的方法和患者的安全性。方法对24例心房颤动伴心动过缓患者行经导管消融治疗心房颤动,消融策略包括环肺静脉电隔离、左心房线性消融及复杂心房碎裂电位(CFAE)消融。观察消融前及术后1个月动态心电图,并记录24h平均心率、最高窦性心率,以超声心动图评价术后6个月左心房直径变化。结果心房颤动消融术后患者平均心率、最高窦性心率均高于术前(P<0.001);术后6个月左心房舒张末期直径减小(P<0.001)。经(19.8±9.9)个月门诊随访,15例(15/24,62.50%)无心房颤动复发,无缓慢型心律失常相关症状;6例患者仍有房性期前收缩或房性心动过速发作,1例患者因心动过缓植入起搏器治疗,余2例心房颤动发作较术前频度减少。结论心房颤动转复时的窦性停搏和心动过缓以及部分快-慢综合征患者的窦房结功能不良可能是源于快速心房率对窦房结功能的抑制。对这部分患者行经导管消融治疗可安全、有效地改善窦房结功能不良,逆转重构。

Objective To evaluate the safety and technique of transcatheter ablation for patients with atrial fibrillation and bradycardia.Methods Twenty-four patients with paroxysmal,persistent or long-standing atrial fibrillation（AF） and bradycardia underwent atrial fibrillation ablation.The procedures included circumferential pulmonary vein isolation,linear atrial ablation and complex fractionated atrial electrogram ablation.The mean and maximum heart rate before and 1month after ablation were assessed by 24-hour ambulatory monitoring.Left atrium size was evaluated by echocardiography 6 months after ablation.Results After AF ablation,the mean heart rate and maximum heart rate were higher than before（all P〈0.001）,and left atrium size decreased at 6months（P〈0.001）.During 19.8±9.9months’follow-up,15patients（15 / 24,62.50%） had no recurrence of AF nor symptoms attributable to bradycardia,6patients had infrequent episodes of atrial tachycardia or premature atrial contraction,1patient required pacemaker implantation,and 2patients had infrequent attacks of AF.Conclusion Prolonged sinus pauses and bradycardia after paroxysms of AF together with some tachycardiabradycardia syndrome may be resulted from depression of sinus node function that can be eliminated by curative ablation of AF.For patients in this situation,transcatheter radiofrequency ablation may be used to safely and effectively improve sinus node function and reverse remodeling of the sinus node.