以终止持续性心房颤动为手术终点的递进式消融200例总结

The summation of step-wise ablation in 200 persistent atrial fibrillation cases using termination as a procedural endpoint

目的总结递进式消融术式治疗持续性心房颤动(简称房颤)的手术过程及临床转归。方法采用递进式消融策略治疗连续200例持续性房颤患者,手术终点为通过单纯消融终止房颤。按以下顺序进行消融:环肺静脉前庭消融达肺静脉电学隔离;心房碎裂电位消融;左房顶部和二尖瓣环峡部线性消融;针对房颤转变而成的房性心动过速(简称房速)行激动标测结合拖带技术明确其机制,并进一步消融终止。经术后3个月空白期,对复发房性心律失常(房颤/房速)的患者进行再次消融。结果 136例患者(68%)术中房颤被消融终止,消融终止房颤组首次术后房性心律失常复发率显著低于未终止组[19.9%(27/136)vs 51.6%(33/64),P<0.01],复发患者经再次消融后,平均随访12.8±7.2个月,本组病例总体手术成功率78.5%(157/200)。消融终止房颤组手术总体成功率高于未终止组[(86.8%(118/136)vs 60.9%(39/64),P<0.01)]。结论递进式消融可能是治疗持续性房颤的一种有效术式。

Objective To summarize the process and clinical outcome of step-wise ablation in persistent atrial fibrilla- tion（AF） cases using termination as a procedural endpoint. Methods Two hundred consecutive patients underwent catheter ablation of persistent AF using a stepwise approach with the desired procedural endpoint being AF termination. Ab- lation was performed in such a sequence ： Circumferential ablation of pulmonary veins to achieve isolation; Ablation at sites possessing complex fractionated atrial electrograms ; linear ablation of the left atrium roof and mitral isthmus ; If AF changed into atrial tachycardia（AT） , activation mapping and entrainment maneuvers were used to define the mechanisms of the tachycardias, then ablation was performed to terminate the tachycardia. Repeat ablation was performed for patients with re- current atrial arrythmias after a 3 month blanking period. Results AF was terminated in136 patients （68%）. There was a lower incidence of atrial arrythmias （AF/AT） in those patients in whom AF was terminated during the index procedure compared with those who had not [ 19.9% （27/136） vs 51.6% （33/64） ,P 〈0.01 ]. After repeat ablation, at 12.8 ：t：7.2 months of follow-up, the total success rate of the procedure was 78.5% （157/200）. Sinus rhythm was maintained in 86. 8% （118/136） in whom AF was terminated compared with 60.9% （39/64） in those in whom AF could not be terminated （ P 〈 0. 01 ）. Conclusion Catheter ablation using the step-wise approach may be an effective way for treating persistent AF.