环状电极标测指导射频消融治疗肺静脉起源的阵发性房颤

Radiofrequency ablation mapping with circumferential catheter for paroxysmal atrial fibrillation originating from the pulmonary veins

背景 常规方法标测射频消融治疗局灶性房颤常导致较长的手术时间及较低的成功率。环状电极标测指导射频消融能够克服这些缺点。目的 评价在 10极环状电极标测指导下射频消融电隔离肺静脉治疗阵发性房颤的可行性和有效性。方法 本组研究包括 16例抗心律失常药物治疗无效的阵发性房颤患者 [男性 11例 ,女性 5例 ,平均年龄 (5 1± 14 5 )岁 ]。 10极的环状标测电极在窦性心律或者冠状窦远端 (CSd)起搏的情况下标测肺静脉 ,确定房性早搏发生的起源 ;一旦确定靶肺静脉 ,肺静脉电位的分布及其激动顺序进行评价 ,射频消融在肺静脉口最早激动处进行。消融终点设定为 :①肺静脉电位消失 ;②肺静脉电位与心房电位无关 ;③房早消失。结果 本组研究总共消融了 36条肺静脉 ,包括 16条左上肺静脉 ,12条右上肺静脉 ,7条左下肺静脉 ,1条右下肺静脉。有 2例消融了 1条肺静脉 ;8例消融了 2条肺静脉 ;5例消融了 3条肺静脉 ;消融 4条肺静脉者 1例。手术时间以及X线曝光时间分别为 (186 7± 6 3 8)min及 (5 1 5± 15 0 )min。在随访的 1～ 12月 ,11例 (6 8 7% )在未服抗心律失常药没有房颤发作 ,其中 2例为再次手术 ,有效者 3例 (18 7% ) ,2例未成功 (12 6 % )。初次术后有 2例发作房早 ,其中 1例服用胺碘酮 ,另外 1?

Objectives To assessed the feasibility and effectiveness of electrophysiological mapping of pulmonary veins with a circumferential 10-electrode catheter and radiofrequency catheter ablation therapy for patients with paroxysmal atrial fibrillation. Background Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. Mapping and ablation pulmonary veins guide with a circular catheter could overcome these limitations. Methods 16 patients [male 11, female 5, mean age (51±14.5) years] with paroxysmal atrial fibrillation refractory to antiarrhythmic drugs were included in this group. A circumferential 10-electrode catheter was used to pulmonary vein mapping during sinus rhythm or CSd pacing to determine the origin of atrial premature contractions. When the ablative target pulmonary vein was found, the pulmonary vein, potentials distribution and activation were assessment pulmonary veins ostial ablation was performed at the segments showing earliest activation of pulmonary vein potentials. The end point was designed: ① elimination of pulmonary vein potential; ② pulmonary vein potential dissociation from artial waves; ③ atrial ectopic beats disappear. Results A total of 36 pulmonary veins were ablated, including 16 left superior, 12 right superior, 7 left inferior and 1 right inferior. 1 pulmonary vein in 2 patients was ablated, 2 pulmonary veins in 8 patients were ablated, 3 pulmonary veins were ablated in 5 patients and 4 pulmonary veins were ablated in 1 patient. Procedure duration and fluoroscopy time respectively were (186.7±63.9) min and (51.5±15.0) min. During the follow-up 1～12 months, 11 patients (68.7%) were free of AF without any antiarrhythmic drugs, 2 of them were reablation, effective in 3/16 (18.7%) and unsuccessful in 2/16 (12.6%). 2 cases recurred with atrial premature, 1 was treated with amiodarone and the other was repeat electrophysiological mapping and ablation, 5 cases with paroxysmal atrial fibrillation recurred, 3 of them were treated with amiodarone (2 cases) or sotalol (1 case), one was implanted with DDDR pacemaker (having programmer of anti-atrial fibrillation), one was repeat ablation. PVs diameter in 2 of them reduced more than 50%, but they were asymptomatic during the follow-up period. 1 case had pneumothorax complication and disappeared after 7 days. Conclusions This study suggests that careful mapping and elimination of these ectopic foci under the guide of circular catheter may have higher success rate and splendid future.