经导管射频消融治疗起源于肺静脉的局灶性心房颤动

Treatment of focal atrial fibrillation arising from pulmonary veins by radio-frequency catheter ablation

目的 :探讨局灶性心房颤动 (房颤 )的诊断和射频消融治疗。方法 :反复发作阵发性局灶性房颤患者4例 ,两次房间隔穿刺经Swartz鞘分别置入 2根标测电极于左、右上肺静脉。在房颤发作时标测 ,以诱发房颤的房性期前收缩局部电位较体表心电图P’波起点最为提前处 (spike p’≥’370ms)为消融靶点。消融终点是以消融前诱发方案不能再诱发房颤和出现严重并发症。结果 :4例均在肺静脉内标测到异位兴奋灶。距离肺静脉口 0 .5～ 1.5cm ,3例位于右上肺静脉 ,1例位于左上肺静脉。靶点处spike p’ =70～ 2 15ms ,行温控 5 0～ 5 5℃× 4 6～ 32 0s射频消融。术后随访 10～ 12个月 ,2例房颤无复发 ,2例加用抗心律失常药物房颤转复 1年后复发。术中 1例左心耳穿孔致急性心包填塞经手术修补完全康复 ,1例在消融时右上肺静脉口痉挛随访期间无症状。结论 :局灶性房颤通过射频消融房性期前收缩起源点 ,可达到根治阵发性房颤的目的 。

Objective:To investigate the diagnosis and radio frequency catheter ablation treatment of focal atrial fibrillation. Method:Four patients (three male and one female) with frequent episodic atrial fibrillation were studied. During the operation, two multielectrode catheters with which the earliest atrial activation was mapped at the onset of atrial fibrillation, were positioned at the left and right superior pulmonary veins respectively by twice interatrial septum puncture. The point with the earliest activation (spike) preceding the p' wave on the surface electrocardiogram (spike p'≥70 ms) was taken as the target point for ablation. The ablation came to the end when atrial fibrillation could not be induced any longer by inducing methods used before the ablation or serious complications occured.Result:The ectopic activity foci were located in the superior pulmonary veins in all the four patients (three in the right and one in the left ). The earliest activation was found to have occurred 0.5 to 1.5 cm inside the veins. On the target points (spike p'=70～215 ms), the catheters temperature were controlled within 50～55℃ and ablations were finished during 46～320 ms. During a follow up of 10～12 months, two patients had no recurrence of atrial fibrillation and the other two received antiarrhythmic defibrillation recurred atrial fibrillation one year later. One patient in whom acute peicardium tamponade occurred because of left auride perforation recovered completely after being repaired. Another patient with entrance convulsion of right superior pulmonary vein during discharge had no symptoms. Conclusion:By radio frequency ablation on original point of atrial ectopic beats in the pulmonary veins, atrial fibrillation can be abolished thoroughly. But there are some dangers and difficulties in the operation.