环肺静脉电隔离联合左心房连续碎裂电位射频导管消融治疗持续性心房颤动的临床研究

Efficacy and Safety of the Continuous Complex Fracfionated Atrial Electrograms followed by Circumferential Pulmonary Vein Isolation for Persistent Atrial Fibrillatn

目的 观察环肺静脉消融（CPVI）联合连续心房碎裂电位（CFAE）射频导管消融治疗持续性心房颤动的有效性和安全性.方法 入选64例经药物治疗无效且有症状的持续性心房颤动（PeAF）患者,CPVI后分为转复窦性心律（A 组）及未转复窦性心律组（B 组）,未转复窦性心律患者行左心房连续CFAE（CFE-mean≤70ms）标测与消融后,分为转复窦性心律组（B1 组）与未转复窦性心律组（B2 组）.两者终点分别为消除所有肺静脉电位与连续CFAE 或转复窦性心律.结果 A 组年龄、术前左心房内径（LAD）、左心室舒张末期内径（LVEDD）及手术前后心房颤动周长（AFCL）明显高于B 组（P＜0.05）.B1 组术前LAD、LVEDD 及手术前后AFCL 明显高于B2 组（P＜0.05）.A 组15 例（23%）与B1组21 例（45%）直接转复为窦性心律,B1组患者中3 例（6%）二尖瓣峡部依赖与2 例（4%）三尖瓣峡部依赖心房扑动经线性消融后转为窦性心律,1 例（2%）二尖瓣环局灶性房性心动过速患者消融后转为窦性心律,28 例（57%）维持心房颤动患者行体外直流电复律成功.随访（5.8±2.3）个月,36 例（56%）维持窦性心律,A 组发生3 例（20%）快速性房性心动过速,明显低于B 组25例患者（51%,P＜0.01）.B1组发生快速性房性心动过速,低于B2组患者（33%、64%,P＜0.01）.术中及术后均未发生严重并发症.结论 CPVI 联合连续CFAE 指导持续性心房颤动射频导管消融术有效安全,CPVI及CFAE消融对于心房电解剖重构程度较低患者的消融效果可能更好.

Objective To investigate the safety and efficacy of radiofrequeney catheter ablation （RFCA） of persistent atrial fibrillation （PeAF） guided with the circumferential pulmonary vein isolation （CPVt） combined the continuous complex fractionated atrial electmgrams （CFAE）. Methods 64 PeAF patients with drug refractory and symptomatic were enrolled. Patients were divided into two groups： patients responded to CPVI （group A） and those not （group B） in terms of termination after CPVI. Patients in group B were seperated into another two groups： patients restored sinus rhythm （SR） after complex fractionated atrial electmgrams （CFAE）（CFE-mean ≥70ms）ablation （group B1） and those not （group B2）. The procedural end point of both ablation strategies were complete the electric isolation of all the pulmonary vein potentials and elimination of continuous CFAE potentials or conversion to SR. Results The larger left atrial diameter （LAD）, larger left ventricular end-diastolic diameter （LVEDD） pre-albation, older age, longer atrial fibrillation cycle length （AFCL） before and after ablation were founded in patients of group A compared with patients in group B （P〈0.05）. The larger LAD and LVEDD pre-albation, longer AFCL before and after ablation were confirmed in patients of group B1 compared with pa- tients in group B2（P〈0.05 ）. SR was directly restored in 15 patients （23%） in group A. 21 patients （45%） in group B1 directly converted to SR, and 3 patients （6%） mitral annulus （MV）-dependent and 2 （4%） tricuspid annulus-dependent atrial flutter were terminated with linear ablation, and a focal atrial tachycardia （2%） originated from MV level was successfully ablated. With a mean follow-up of 5.8 ± 2,3 months, SR was restored in 36 patients （56%）. Fast atrial tachycardia （SAT） were observed in 15 patients in group A and were 25 patients in group B （20%vs51%,P〈0.01）. 7 patients in group B 1 and 18 patients in group B2 occured SAT （33%vs64%,P〈0.01）. 21 patients （43%） were remained in AF after combination of the 2 described approaches, SR was restored by electrical cardioversion. No major complications have been observed inthese patients during or after the proceduresd. Conclusion RFCA AF guided by CPVI followed by continuous CFAE is safe and effective to treat patients with PeAF. Patients with less anatomical and electrical remodeling were prone to be restored SR with CPVI and CFAE ablation.