阵发性房颤患者大静脉肌袖与心房电连接特征的临床研究

Characteristics of electrophysiological connection between atria and myocardial sleeves in patients with paroxysmal atrial fibrillation

目的 总结阵发性房颤病人肺静脉和 /或上腔静脉肌袖的电生理标测和导管射频消融电隔离的结果 ,评价国人大静脉肌袖和心房的电连接类型和特点。资料与方法 :顽固性阵发性房颤患者 45例 ,在环状标测电极指导下行大静脉肌袖的电位记录、分析以及对能标测到袖电位的大静脉进行开口部的点或段的消融电隔离治疗。根据窦律和心房起搏下的肌袖内环形电极标测到的袖电位的激动顺序以及有效放电对袖电位的影响 ,总结和分析袖房之间的电连接特点。结果 共标测和 /或电隔离肌袖 115根 ,其中肺静脉 10 0根 ,上腔静脉 15根。其中呈单束状电连接 43根 (3 8% ) ,双束状电连接 5 4根 (4 6% ) ,多束状电连接 12根 (10 % ) ,环状电连接 3根 ,无电连接 3根。结论 根据环状电极标测到的袖电位的激动顺序和对放电的反应 ,提示袖房之间电连接的类型多为单束状和双束状(84% ) ,说明对于大多数肌袖并不需要行环状消融 。

Objective:The Characteristics of electrical connections between atria and myocardial sleeves were evaluated by summarizing the mapping and ostial ablation data of pulmonary veins(PV) and superior vena cava(SVC) in patients with paroxysmal atrial fibrillation (PAF).Methods:Forty-five patients referred for electrical isolation of myocardial sleeves by radiofrequency ablation to control drug-resistant PAF were enrolled. Guided by circular mapping catheter, the activation sequence of myocardial sleeve potential during sinus rhythm and atrial pacing and its response to effective radiofrequency current delivery were analyzed. Results:115 veins, including 100 PVs and 15 SVCs, were mapped and ablated. In electrophysiology, one bundle connections were found in 43 veins(38%), two bundle connections in 54(46%), multiple bundle connections in 10(10%), circumferential connections in 3 and no connection in 3. Conclusion:Guided by circular mapping and radiofrequency ablation of PV and SVC, 84% myocardial sleeves can be defined as one bundle and two bundle electrophysiological connections, which suggested that the circumferential ablation is not necessarily needed to electrophysiologically disconnect the PVs and SVCs from the atria in most patients with PAF.