阵发房颤合并病窦综合征的射频消融治疗

The effects of catheter radiofrequency ablation in patients with refractory paroxysmal atrial fibrillation associated with sick sinus atrial node syndrome

目的总结顽固性阵发性房颤伴病窦综合征患者的心电图和动态心电图特点。评估心脏起搏和射频消融心房肺静脉电隔离治疗的结果。方法 5例阵发性房颤患者。年龄62（60.7±6.8）岁。4例有黑朦,1例有晕厥发作史,病史1~5（2.6±1.3）年。全部病例完行心内电生理检查和心房肺（或上腔）静脉电隔离。结果5例患者中,每周均有发作数次的3例,有2例植入DDD心脏起搏器,其中1例系导管射频消融术后1周植入起搏器,另1例系植入起搏器后房颤频繁发作行导管射频消融。动态心电图示房颤终止后的平均窦性停搏时间为5（5.0±1.9）s。心内电生理检查证实与房颤相关的靶静脉为上腔静脉1例,右上肺静脉1例,左上肺静脉2例,有1例未能确定起源点。作射频消融电隔离肺静脉共22根,平均随访3（2.78±1.59）月,无房颤发作。未植入起搏器的3例多次动态心电图复查无窦性停搏发生,24h总心率均在正常范围。结论部分阵发性房颤伴病态窦综合征的患者,导管射频消融电隔离肺静脉后能有效地消除房颤发作,窦房结功能可以恢复。建议对这些患者首先行肺静脉电隔离治疗控制房颤,然后根据自身心率的变化评估心脏起搏治疗的必要。

Objective To summarize the refractory paroxysmal atrial fibrillation（Af） associated with sick sinus atrial node syndrome patients electrocardiogram（ECG） and dynamic ECG characteristics. to evaluate cardiac pacemaker and catheter radiofrequency ablation for atrial pulmonary vein electrical isolation results. Methods Five patients with paroxysmal atrial fibrillation. Four cases of amaurosis, 1 case with a history of syncope attack. History of1~9（3.6±1.3） years. All patients completed intracardiac electrophysiology examination and catheter radiofrequency ablation for atrial pulmonary cavity or venous electrical isolation treatment after the clinical routine examination.Results Five patients, have attack several times a week 3 cases, 2 cases were implanted with DDD pacemaker,including 1 case of catheter radiofrequency ablation after 1 week, another case of implanted pacemaker can＇t control the onset of atrial fibrillation. Dynamic electrocardiogram（ECG） in atrial fibrillation after the termination of the average sinus arrest time was 5（5.0±1.9） seconds. Intracardiac electrophysiological examination confirmed target vein associated with atrial fibrillation for superior vena cava 1 case, right upper pulmonary veins 1 case, left upper pulmonary vein 2 cases, 1 case failed to determine the origin point. Radiofrequency ablation electrical isolated pulmonary vein 22, the average follow-up was 4（2.78±1.59） months, there was no the onset of atrial fibrillation. No implanted pacemaker 3 cases of multiple dynamic ECG review no sinus cardiac arrest occurred, 24 h total heart rate in the normal range. Conclusions paroxysmal atrial fibrillation in patients with sick sinus syndrome, electrical isolated pulmonary vein can effectively eliminate atrial fibrillation attack, the sinoatrial node function can be restored, Advice on the first line of pulmonary vein in these patients, then according to their own heart rate changes to evaluate cardiac pacemaker therapy.