环肺静脉电隔离术对阵发性心房颤动患者肺静脉电生理特性的影响

Influence of circumferential pulmonary vein isolation on electrophysiologic properties of pulmonary veins in patients with paroxysmal atrial fibrillation

目的探讨环肺静脉电隔离术(CPVI)对肺静脉电生理特性的影响。方法纳入抗心律失常药物治疗无效的阵发性心房颤动(房颤)且初次行CPVI治疗的患者26例,CPVI前、后分别测量肺静脉和左心房的有效不应期(ERP)、相对不应期(RRP),比较CPVI前、后肺静脉和左心房ERP、RRP的变化。结果 26例阵发性房颤患者共隔离104根肺静脉,术后即刻均为窦性心律。CPVI前、后肺静脉舒张期起搏阈值分别为(3.2±0.6)V vs.(3.3±0.5)V,P>0.05。CPVI前肺静脉的ERP(n=82)、RRP(n=35)时间短于左心房,分别为(187±60)ms vs.(229±31)ms(P<0.001);(223±45)ms vs.(261±34)ms(P<0.05)。CPVI后肺静脉ERP(n=47)、RRP(n=26)时间和左心房均无统计学差异,分别是(245±38)ms vs.(234±43)ms(P>0.05),(268±44)ms vs.(245±41)ms(P>0.05)。CPVI后肺静脉ERP(n=47)、RRP(n=21)较CPVI前显著延长,分别是(245±38)ms vs.(187±76)ms(P<0.05);(259±44)ms vs.(230±47)ms(P<0.05)。结论 CPVI隔离肺静脉和左心房之间的电传导,同时也改变了肺静脉的电生理特性,降低了其致心律失常特性。

Objective To investigate influence of circumferential pulmonary vein isolation （CPVI） on electrophysiologic properties of pulmonary vein.Methods The patients （n=26） with paroxysmal atrial fibrillation （PAF）, without curative effect after treated with anti-arrhythmia drugs and for the first time with CPVI, were chosen. The effective refractory period （ERP） and relative refractory period （RRP） of pulmonary vein and left atrium were detected, and the changes of ERP and RRP of pulmonary vein and left atrium were compared before and after CPVI. Results There were totally 104 pulmonary veins isolated in 26 patients and they had sinus rhythm immediately after surgery. Before and after CPVI, diastolic pacing threshold of pulmonary vein was, respectively, （3.2±0.6） V vs. （3.3±0.5） V, （P〉0.05）. Before CPVI, ERP （n=82） and RRP （n=35） of pulmonary vein were shorter than those of left atrium （187±60） msvs. （229±31） ms （P〈0.001） and （223±45） msvs. （261±34） ms （P〈0.05）. After CPVI, ERP （n=47） and RRP （n=26） of pulmonary vein had no statistical difference compared with those of left atrium （245±38） msvs. （234±43） ms （P〉0.05） and （268±44） msvs. （245±41） ms （P〉0.05）. After CPVI, ERP （n=47） and RRP （n=21） of pulmonary vein were significantly longer than those before CPVI （245±38） msvs. （187±76） ms （P〈0.05） and （259±44） msvs. （230±47） ms （P〈0.05）.Conclusion CPVI insulates the electric conduction between pulmonary vein and left atrium, meanwhile changes and decreases electrophysiologic and arrhythmogenic properties of pulmonary vein.