高密度标测下消融持续性心房颤动临床观察

Clinical observation of persistent atrial fibrillation ablation under the high density mapping

目的探讨持续性心房颤动(简称房颤)患者环肺静脉电隔离(CPVI)术后再次行心房高密度基质标测,存在低电压区和/或疤痕区域的患者进一步行相关基质改良的价值。方法选取2013年5月至2015年5月在本中心首次接受三维标测系统指导下CPVI术及术后行心房高密度基质标测的129例持续性房颤患者。35例经高密度基质标测证实左房无低电压区和/或疤痕区,作为A组。94例患者左房存在低电压区和/或疤痕区,选取其中29例不进行相关基质改良,作为B组;选取34例针对低电压区和/或疤痕区再次进行基质改良,作为C组;另31例仅针对房顶及二尖瓣峡部进一步行线性消融,作为D组。比较各组射频消融手术成功率的差异性。结果 A、B、C、D组患者随访1年的单次手术成功率分别为65.7%、31%、64.7%、58.1%,4组患者单次手术成功率比较差异有显著性(P<0.05);A、C、D组的成功率明显高于B组(P<0.01或0.05)。结论以心房高密度标测为指导的基质改良有可能进一步提高持续性房颤射频消融的手术成功率。

Objective To investigate the circumferential pulmonary vein isolation（CPVI） postoperative again for high density matrix mapping in patients with persistent atrial fihrillation（AF）, the existence of the low voltage re- gion and/or scar area of patients for further related matrix modified value. Method One hundred and twenty-nine patients with persistent AF were enrolled as research objects, which were the first time to accept the three-dimen- sional mapping system under the guidance of CPVI and further testing system of atrial high density matrix mapping in 3D object in our centre from May 2013 to May 2015. Thirty five patients were enrolled as group A, which were approved without low voltage region and / or scar area in the atrial by high density matrix mapping. Ninety-four pa- tients were existing low voltage region and / or scar area in the atrial.Selected 29 patients as group B,which were not to further related matrix modification.Selected 34 patients as group C, which were only in view of the low voltage re- gion and / or scar zone again matrix modified radio frequency ablation.Selected other 31 patients as group D, which were only in view of the roof of the atrium and the mitral isthmus for further linear ablation.Compared the difference of success rate of radio frequency ablation with each group. Results The follow-up single operation success rate of one years of patients of group A, B, C, D was respectively 65.7%, 31%, 64.7 %, 58.1%. There was significant differ- ence among /our groups about single operation success rate of patients（P〈0.05）.The single operation success rate of group A,C,D were respectively higher than that of group B（P〈0.01 or 0.05）. Conclusion To use atrial high density mapping as matrix improved guidance may further improve persistent AF radiofrequency ablation operationsuccess rate,