阵发性心房颤动经导管射频消融治疗评价

Evaluation of radiofrequency catheter ablation in treating patients with paroxysmal atrial fibrillation

目的 探讨经导管射频消融治疗阵发性心房颤动 (房颤 )的安全性和有效性。方法 74例发作频繁、药物治疗无效的阵发性房颤 ,前 5 0例的消融靶点为房颤特异性早搏或房颤的起源部位 ,消融终点为自发和诱发的房颤特异性早搏或房颤消失 (终点 1) ;后 2 4例的消融靶点为致心律失常性肺静脉的开口部 ,消融终点为该肺静脉的肺静脉电位消失 (终点 2 )。结果 共发现 111个异位灶 ,行76次消融术 ,有 5 8例 (78 4% )达到消融终点。随访 1～ 31(12 9± 6 6 )个月 ,2 3例 (31 1% )消融成功 ,可以无需药物而维持窦性心律。术中达到消融终点者的成功率为 39 7% (2 3例 / 5 8例 ) ,其中达终点 1者为 34 1% (15例 / 44例 ) ,达终点 2者为 5 7 1% (8例 / 14例 )。并发症 :无症状的单支肺静脉狭窄 5例(6 8% )、气胸 1例 (1 4% ) ,均发生于本组的前 30例中。结论 经导管射频消融治疗阵发性房颤较为安全 ,但成功率尚待提高 ,目前可用于部分发作频繁、症状严重、而且药物治疗无效的患者。

Objective To investigate the efficacy and safety of radiofrequency catheter ablation in treating patients with paroxysmal atrial fibrillation (AF). Methods Seventy-four drug refractory AF patients with frequent attacks were referred for catheter ablation. Radiofrequency ablation was performed by targeting the source of AF specific ectopy or AF in the first 50 patients with the procedural endpoint of induced AF specific ectopy or AF suppression (endpoint 1), and by targeting the ostia of arrhythmogenic pulmonary veins in the later 24 patients with the procedural endpoint of pulmonary vein potentials elimination (endpoint 2 ). Results A total of 111 foci were identified and 76 cases of ablation were performed. Fifty-eight patients (78.4%) achieved the procedural endpoint. After a mean follow-up of 1-31(12.9±6.6) months, AF was completely eliminated in 23 patients (31.1%) without antiarrhythmic drug (success). The success rate was 34.1%(15/44) in patients who achieved endpoint 1, and 57.1%(8/14) in patients who achieved endpoint 2. Complications occurred as follows :single pulmonary vein stenosis (defined as a diameter reduction ≥50%) without symptoms was observed in 5 patients (6.8%). One patient (1.4%) had pneumothorax. All complications occurred in the first 30 patients. Conclusions Radiofrequency catheter ablation is safe for treatment of paroxysmal AF, but its efficacy remains to be improved. This treatment is presently indicated in patients with paroxlysmal AF who are multidrug resistant and symptomatic with frequent attacks.