肺静脉外触发灶在阵发性心房颤动患者消融中的价值

The value of non-pulmonary vein focus in ablation of paroxysmal atrial fibrillation

目的评估阵发性心房颤动肺静脉外触发灶射频导管消融（下称消融）的临床疗效.方法选择接受消融的阵发性心房颤动患者298例,其中男性96 例,女性202例,年龄57～71（63.0±10.4）岁.根据消融情况分为3 组.A 组未诱发出肺静脉外触发灶;B 组：心房颤动起源于肺静脉外触发灶并成功消融所有触发灶;C组：心房颤动起源于肺静脉外触发灶,但触发灶未能彻底消融.比较3组患者的临床特征以及心房颤动触发灶的分布及消融结果.结果A 组患者243 例,B 组32例,C 组23 例.3 组患者临床特征、肺静脉触发灶发生率无明显差异.B、C组患者的上腔静脉隔离率、左心房顶部线性消融、左心房底部线性消融均明显高于A组,差异均有统计学意义（均P〈0.05）.术后3组平均随访（25.3±10.6）个月,C 组心房颤动复发率[69.56%（16 例）]与A 组、B 组[9.8%（24 例）、9.37%（3 例）]比较,差异均有统计学意义（P〈0.01）.结论肺静脉外触发灶的诱发和成功消融有助于提高阵发性心房颤动患者的手术成功率.

Objective To explore clinical efficacy of radiofrequency catheter ablation of non-pulmonary vein（PV）focus in paroxysmal atrial fibrillation （PAF）. Methods 298 consecutive PAF patients （203 males, age 63.0±10.4 years）underwent ablation were divided into group A （243 patients） without non-PV ectopy, group B （32 patients） with non-PVectopy as the trigger of PAF and ablated successfully, and group C （23 patients） with non-PV ectopy as the trigger of PAFbut not ablated completely. Clinical features, distribution of foci and ablation results were compared between groups.Results Clinical features and the incidence of PV focus were similar in the three groups. The rate of superior vena cavaisolation, linear ablation of left atrial roof and floor were significantly higher in groupB andC than in group A. The recurrencerate of atrial fibrillation was significantly higher in group C（68%） than in group A（9.8%） and group B（8.8%） during follow upof （25.3±10.6）months（P〈0.01）. Conclusion Inducing and successfully ablating non-pulmonary vein ectopy mayimprove the success rate of procedure in patients with PAF.