局灶消融治疗阵发性心房颤动

Catheter ablation of foci for atrial fibrillation

目的 探讨心房纤维性颤动 (简称房颤 )经导管射频消融术的治疗方法、疗效、安全性 ,及其激动与折返机制。方法 对14例阵发性房颤患者行射频消融术治疗 ,前6例采用肺静脉或肺静脉口消融术 ;后8例采用非接触心内膜激动标测系统 (Ensite3000)标测引导下 ,消融房颤最早激动点和线状消融相关的折返途径。结果肺静脉或肺静脉口消融的6例 ,成功3例 ,复发1例 ,未成功3例 ;用Ensite3000标测引导消融8例 ,成功4例 ,明显有效4例。结论 肺静脉或肺静脉口消融对部分起源于肺静脉的阵发性房颤有效 ;用Ensite3000标测引导消融能准确标测房颤的激动起源、传导方向、折返部位 ,能够精确指导射频消融术以最简捷的消融点线消融房颤折返的关键部位 。

Objective To study the methodology,effectievess and safety of radiofrequency catheter ablation(RFCA) and to explore the mechanism of activation and reentry path in atrial fibrillation(AF).Method RFCA was performed in 14 patients with paroxysmal AF.Six patients underwent RFCA through pulmonary vein or pulmonary vein orifice.In another 8 patients,RFCA was performed with guidance of noncontact mapping system to ablate original activation focus and linely ablate relevant reentry path.Result In 6 patinets ablated by pulmonary vein or pulmonary vein orifice,3 had successful ablation of AF including one had recurrence late and 3 failed.In another 8 cases guided by noncontact mapping system 4 had successful ablation,and 4 had significant improvement.Conclusion Ablation by pulmonary vein or pulmonary vein orifice is effective for AF originating from pulmonary vein and noncontact mapping system(Ensite 3000) is more effeitive in ablation of AF.