小剂量伊布利特辅助的持续性心房颤动导管消融治疗

Low-dose ibutilide facilitated catheter ablation for persistent atrial fibrillation

目的：报道小剂量伊布利特辅助下进行持续性心房颤动（房颤）导管消融治疗的初步结果。方法前瞻性入选2011年11月至2013年4月连续102例在首都医科大学附属北京朝阳医院心内科接受导管消融治疗的持续性房颤患者,其中男68例,女34例,平均年龄（62±11）岁。首先行环肺静脉电隔离术（ CPVI）,然后静脉给予0．25 mg的伊布利特,观察30 min。如房颤转复为窦性心律（ SR）则不予进一步的心房基质改良；如房颤转为房性心动过速（ AT）则仅消融AT；如仍为房颤,则行心房碎裂电位（ CFAE ）消融,直至 SR 恢复或 CFAE 已被消除或 CFAE 消融时间已达30 min。结果41例（40．2%）患者经CPVI±小剂量伊布利特后房颤被终止（SR或者AT）为组1。其余61例（59．8%）患者进一步接受了平均时间为（14．0±5．6） min 的CFAE消融,其中25例（41．0%）患者房颤被终止为组2；36例患者经电复律恢复SR为组3。平均随访（501±224） d,单次消融成功率为69．6%（71例）。组1和组2的成功率（分别为82．9%和76．0%）显著高于组3（50．0%,P值均〈0．01）。结论小剂量伊布利特辅助的持续性房颤导管消融术疗效可以接受,并在实时评估房颤维持基质及减少无效CFAE消融等方面具有潜在优势。

Objective To report the efficacy of low-dose ibutilide facilitated catheter ablation for per-sistent atrial fibrillation（PsAF）. Methods One hundred and two consecutive patients [68 men,34 women, mean age of（62±11）years] who underwent index catheter ablation for PsAF were enrolled from November 2011 to April 2013 in this prospective study. After circumferential pulmonary vein isolation （ CPVI ） , low-dose （0. 25 mg） ibutilide was administered over 3 min in patients without PsAF termination. In case of PsAF was terminated,either converted to sinus rhythm（ SR） or transformed to atrial tachycardia（ AT） by ibutilide within 30 minutes,no further ablation targeting complex fractionated atrial electrogram（ CFAE） was performed. In con-trast, CFAE ablation was performed until SR restored or all CFAE was eliminated or CFAE ablation time achieved 30 minutes. Results In 41（40. 2%） patients,PsAF was terminated by CPVI±ibutilide（Group 1）. Further CFAE ablation was performed in another 61（59. 8%） patients,in whom PsAF was terminated by CFAE ablation in 25 patients（Group 2） or by external cardioversion in 36 patients（Group 3）. The mean CFAE abla-tion time was（14. 0±5. 6） min. After a mean follow-up of（501±224） d,the success rate after the index ablation procedure was 69. 6%（71 patients）. The success rate of Group 1 and Group 2 was 82. 9% and 76. 0%,respec-tively. Both were significantly higher than that in Group 3（50%,P〈0. 01 for both）. Conclusion The efficacy of low-dose ibutilide facilitated catheter ablation for PsAF is acceptable,with potential strengths in on-line eval-uating the atrial maintenance substrate and reducing ineffective CFAE ablation.