长程持续性心房颤动消融策略与方法探索

Ablation strategies and methods for long standing persistent atrial fibrillation

目的:持续性心房颤动的消融策略一直存在争议,远期成功率也有待提高,本研究旨在探索一种新的持续性心房颤动消融策略和方法。方法:入选10例长程持续性心房颤动患者,消融策略主要包括肺静脉前庭隔离、左心房后壁隔离、Marshall静脉无水酒精消融和二尖瓣峡部线性消融。第一步:Marshall静脉无水乙醇消融;第二步:患者常规完成双侧环肺静脉隔离;第三步:完成左心房后壁隔离;第四步:完成二尖瓣峡部线性双向阻滞。结果:入选患者心房颤动持续时间(23.4±8.0)个月。所有患者成功完成Marshall静脉无水乙醇消融,消耗(31.5±4.4)min;所有患者完成双侧肺静脉隔离,消耗(50.3±5.4)min;所有患者成功完成左心房后壁隔离,消耗(20.2±2.5)min,左后后壁内补点消融(3.0±2.7)次,消耗(12.8±3.1)min。1例患者术中后壁隔离后变为三尖瓣峡部心房扑动,消融后转窦,其他患者电复律为窦律。所有患者总计手术时间(149.7±10.4)min。9个月随访期间所有患者未出现心房颤动、心房扑动等心律失常。结论:本研究报道了一种持续性心房颤动新的消融策略,涉及到既往认为参与心房颤动及心房扑动触发维持的解剖结构,方法学上是可行的,并且短期随访效果较好,有待进一步大样本前瞻性研究证实。

Objective: The ablation strategy of persistent atrial fibrillation(AF) was controversial,and the long-term success rate needs to be improved. This study aims to explore a new ablation strategy and method of persistent AF. Methods: Ten patients with long-term persistent AF were enrolled. The ablation strategies mainly included pulmonary vein isolation(PVI), left atrium posterior wall isolation(PWI),vein of Marshall(VOM) ethanol infusion, and mitral isthmus linear ablation. Results: AF duration time of the patient enrolled was(23.4±8.0) months. Step 1: VOM ethanol infusion was successfully completed by all patients [mean time of(31.5±4.4)minutes];Step 2: PVI was routinely completed in all patients [mean time of(50.3±5.4) minutes];Step 3: LA PWI was successfully completed in all patients [mean time of(20.2±2.5) minutes];Step 4: The mitral isthmus bidirectional block was successfully completed in all patients [mean time of(12.8±3.1) minutes]. AF turned into atrial flutter after PWI in one patient, and sinus rhythm was obtained after tricuspid isthmus ablation. The sinus rhythm was obtained after electrocardioversion in the other 9 patients. During the 9-month follow-up period, all patients had no arrhythmias such as atrial fibrillation and flutter. Conclusions: This study reported a new ablation strategy for persistent AF, involving anatomical structures previously identified as possibly involved in the fibrillation and flutter process. It is methodologically feasible, and the result provided good short-term outcomes. Although promising, these preliminary results need to be confirmed in the larger prospective study.