肺静脉前庭隔离联合碎裂电位指导线性消融治疗持续性心房颤动

Clinical evaluation of linear ablation following circumferential pulmonary vein isolation for persistent atrial fibrillation guided by complex fractioned atrial electrogram

目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)指导的线性消融进行心房基质改良的疗效。方法分析66例持续性心房颤动(简称房颤)消融病例,所有患者标测碎裂电位,行环肺静脉隔离后根据标测结果设计消融径线。明确消融术中房颤终止比例及随访疗效。结果所有入选患者CFAEs分布比例从高向低依次为:肺静脉前庭、左房间隔、顶部、前壁等,消融径线主要为顶部线、前壁线、间隔线、峡部线等。入选患者平均消融线(1.9±0.4)根。随访(16.5±3.9)个月,52例(78.8%)患者经过一次消融术未再发心律失常。14例复发,1例为典型心房扑动,10例为阵发性房颤,1例为持续房颤,2例房性心动过速。结论持续性房颤接受CPVI附加CFAEs标测后线性消融有效、安全。

Objective To evaluate the efficiency of substrate modification using linear ablation following circumfer- ential pulmonary vein isolation（CPVI） guided by complex fractionated atrial electrograms （CFAEs） ablation on pa- tients with persistent atrial fibrillation（AF）. Methods Sixty-six persistent AF patients were included in the study. CFAEs mapping was conducted by CARTO system. CPVI was first applied, followed by linear ablation guided by result of CFAEs mapping.The procedural parameters such as proportion of AF termination and subsequent clinical effectiveness were evaluated among these groups. Results From high to low of the distribution ratio of CFAEs were, in order, pulmonary vein antrum, septum, roof, anterior wall etc. The ablation lines included the anterior wall line, roof line, septum line and isthmus line etc. The mean ablation lines was （1.9±0.4） for each patient. Dur- ing （16.5±3.9） months of follow-up after a single ablation procedure, 78.8% of patients were in sinus rhythm with- out antiarrhythmic drugs, 14 patients had a recurrence of AF after the first procedure. One patient had atrial flutter, 10 patients had paroxysmal AF, One patient had persistent AF and two patients had atrial tachycardia （AT）. Con- clusion Linear ablation guided by CFAEs followed by CPVI is safe and effective to treat patients with persistent AF.