希浦系统起搏联合房室结消融治疗多次消融后复发的持续性心房颤动

His-Purkinje system pacing combined with atrioventricular node ablation in treating recurrent persistent atrial fibrillation after multiple ablation

目的:对于多次导管消融术后复发的症状性持续性心房颤动(房颤)患者,行房室结消融联合希浦系统起搏治疗,观察是否能够改善目标人群的生活质量及缓解临床症状,评估手术是否安全有效。方法:纳入既往至少两次射频消融术后复发的症状性持续性房颤患者,行希浦系统起搏及房室结消融治疗,统计手术成功率及并发症。术后随访6个月,观察希浦系统起搏参数是否稳定。术前评价患者房颤症状及生活质量,并进行6 min步行试验,同术后6个月随访时比较,观察有无改变。结果:共31例患者手术,希浦系统起搏成功率100%(22例行希氏束起搏,9例行左束支起搏);房室结消融成功率93.3%。术后6个月随访显示,患者房颤症状及生活质量显著改善,6 min步行距离显著提升,希浦系统起搏的阈值无显著差异,无严重并发症出现。结论:对于多次射频消融术后复发的症状性持续性房颤患者行希浦系统起搏联合房室结消融治疗,短期随访显示可以显著改善患者临床症状,提升生活质量,手术安全有效。

Objective:For patients with symptomatic persistent atrial fibrillation(AF)who recurred after multiple catheter ablation,atrioventricular node ablation combined with His-Purkinje system pacing is performed to observe whether it can improve the quality of life and alleviate clinical symptoms,and evaluate whether the therapy is safe and effective.Methods:Patients with symptomatic persistent AF who recurred after at least two radiofrequency ablation were treated with His-Purkinje system pacing and atrioventricular node ablation,the success rate and complications were recorded.All included patients were followed up for 6 months to observe whether the pacing parameters of His-Purkinje system were stable.The AF symptoms,quality of life,and 6-min walking distance before and 6 months after operation were compared.Results:Thirty-one patients underwent His-Purkinje system pacing and atrioventricular node ablation.The success rate of His-Purkinje system pacing was 100%(22 cases underwent His bundle pacing and 9 cases underwent left bundle branch pacing);The success rate of atrioventricular node ablation was 93.3%.The 6-month follow-up showed that the AF symptoms,quality of life,and 6-minute walking distance were significantly improved,there was no significant difference in the pacing threshold of His-Purkinje system pacing,and there were no serious complications.Conclusion:For symptomatic persistent AF patients who recurred after multiple radiofrequency ablation,His-Purkinje system pacing combined with atrioventricular node ablation can significantly improve the clinical symptoms and quality of life in a short-term follow-up,the operation is safe and effective.