超声消融治疗局灶性房颤临床研究

Catheter ultrasound ablation used to treat focal atrial fibrillation

目的 :探讨在肺静脉造影和标测电位指导下 ,以超声球囊导管消融肺静脉口治疗局灶性房颤的近远期疗效。方法 :采用肺静脉超声消融。结果 :9例患者共确定 2 4条靶肺静脉 ,即左、右上肺静脉各 9条 ,左下肺静脉 6条。消融 (4 3± 1 5 )次 ,实际温度 (5 7 2± 3 6 )℃ ,每次消融时间 (96 8± 12 5 )s ,每例平均消融 (378 6± 4 1 3)s ,肺静脉电位振幅降低 80 %以上。消融中 9例患者均有胸痛 ,7例需静脉注射吗啡缓解 ,无并发症。房颤于术后(4 8 3± 11 7)h复发 ,均开始服用抗心律失常药物。随访 (11 8± 7 5 )月 ,房颤发作从术前每周 (5 7± 3 9)次减少到 (3 4± 2 3)次。结论 :①以房早消失、肺静脉电位振幅降低和实际消融温度不能作为即刻疗效终点 ,②晚期肺静脉口重构效应能减少局灶性房颤的远期发作 ,③超声球囊导管消融靶肺静脉后房颤的近期复发不能代表远期疗效。

Objective:The purpose of the study is to evaluate the effect of pulmonary vein angiogram (PVA) and spike potential (PSP) mapping guided ultrasound ablation in the pulmonary vein ostium (PVO) to treat focal atrial fibrillation (Af) Methods:The target PVO of enrolled patient with paroxysmal Af was 1 clear and stable PSP, 2 earliest APB orientation, 3 PSP driven or triggered Af An ultrasound balloon catheter was inserted through atrial septum to ablate target PVO with the parameters of temperature ≥50℃ and time 60～120s The end points were PSP disappeared or its amplitude decreased more than 80%, complete conduction block from PVO to the left atrium and actual ablation temperature ≥50℃ for more than 60s Results:Total 24 PVOs of 9 pts were ablated Each PVO was ablated (4 3±1 5) times with actual temperature of (57 2±3 6) ℃ and duration of (96 8±12 5)s The PSP of 12 PVOs disappeared and the amplitude of others were decreased more than 80% There were no complications All pts had Af recurred within (48 3±11 7) hours after ablation Af was decreased from (5 7±3 9) to (3 4±2 3) per week in follow up of 11 8±7 5 month ( P (0 05) Conclusions:1 The end point of APB and PSP disappearance, actual temperature ≥50℃ can not predict immediate and long term ablation effect of focal Af 2 Late remodeling effect of ablated PVO may be one factor to reduce Af attack 3 The method of PVA and PSP mapping guided ultrasound ablation in PVO may be not a radical care to focal Af