肺静脉电隔离术联合碎裂电位消融治疗持续性房颤疗效观察

Curative effect evaluation of pulmonary vein isolation associated with complex fractionated atrial electrograms ablation in treating persistent atrial fibrillation

目的观察肺静脉电隔离术(pulmonary vein isolation,PVI)联合碎裂电位(complex fractionated atrial electrograms,CFAE)消融对持续性房颤的疗效。方法对比观察23名于本院行房颤射频消融术的持续性房颤患者,所有患者均行PVI及左房顶部线性消融,其中12例联合CFAE消融,术后随访1年;观察两组手术时间、X线曝光时间、消融时间、手术并发症、左房大小、左房血栓、一次手术成功率等指标。结果联合CFAE消融组总手术时间(252±35)min、X线曝光时间(42±9.1)min、消融时间(94±11)min,单纯行PVI组分别为(176±22)min、(34±7.6)min、(63±8)min,联合CFAE消融组手术各时间均明显延长(P<0.01);两组手术并发症、对左房大小及左房血栓的影响比较差异均无统计学意义;联合CFAE消融组一次手术成功率(75%)明显高于单纯行PVI组(64%)(P<0.05)。结论 PVI联合CFAE消融治疗持续性房颤虽增加手术、消融及X线曝光时间,但并不会提高并发症发生率,可提高房颤消融的一次手术成功率。

Objective To observe the effects of pulmonary vein isolation （ PVI） associated with complex fractionated atrial electrograms （ CFAE） ablation on patients with persistent atrial fibrillation （ AF） .Methods Twenty-three patients with persistent AF were enrolled in the study .All of them had been treated by PVI and linear ablation in left atrium , among whom 12 cases were additionally given CFAE ablation .During a one-year follow-up, several indexes were compared between the two groups , including the duration of operation , X-ray exposure time , ablation time , surgical complica-tions, internal diameter and thrombus of left atrium , success rate of once operation , etc.Results Compared with PVI group, the total time of operation [（176 ±22） min vs.（252 ±35） min], X-ray exposure time[（34 ±7.6） min vs.（42 ±9.1） min], and ablation time[（63 ±8） min vs.（94 ± 11） min] was significantly increased in PVI ＋CFAE group （ P〈0 .05 ） .The differences of surgical complications, and the influences on internal diameter and thrombus of left atrium were not statisti-cally significant .The success rate of once operation in PVI associated with CFAE ablation group was significantly higher than that in PVI group （75%vs.64%;P〈0.05）.Conclusion In the treatment of persistent atrial fibrillation , although PVI associated with CFAE ablation lengthens the time of operation , X-ray exposure time , and ablation time , it will not increase the incidence of complica-tions and can elevate the success rate of once operation in atrial fibrillation ablation .