单一靶静脉电隔离治疗阵发性心房颤动的疗效评价

Insight to the Effectiveness of Single Atrium-Vein Electrical Isolation to Patients With Paroxysmal Atrial Fibrillation

探讨阵发性心房颤动 (PAF)靶静脉的标测方法 ,评价电隔离单一靶静脉的临床效果。选择 2 0 0 1年 8月～2 0 0 3年 5月 90例连续住院PAF病人中进行单一静脉电隔离的 14例病人。男 10例、女 4例。年龄 5 1± 10 (39～6 4 )岁。均有频发的PAF。常规放置冠状静脉窦电极导管、右室尖部电极导管。进行两次房间隔穿刺。放置环形标测电极导管 (LASSO电极 )以及大头消融电极导管。进行肺静脉 (PV)和 /或上腔静脉 (SVC)标测。以心律失常的始发激动最早 ,并且明显比体表心电图的心房电位提前、电活动频率最快的PV或SVC为靶静脉 ,进行电隔离。结果 :全部病例即刻电隔离均获成功。 10例病人电隔离靶静脉后 ,静脉肌袖内无自发的电活动。 4例病人靶静脉电隔离后 ,静脉肌袖内仍存在电活动。 5例PV电隔离术后PAF再发病例中 3例再次进行经验性其它PV电隔离。随访 10 .5± 9.2月。停用任何抗心律失常药物 ,11例无临床症状及PAF证据。进行单一静脉电隔离的成功率为6 4 .3% (9/ 14 ) ,其中进行单一PV电离的成功率为 4 4 .4 % (4/ 9)。 5例SVC电隔离术后无复发。结论 :PV相关的PAF在不同时段内可能由不同的PV肌袖触发或驱动PAF发生。单一静脉电隔离可能仅适用于较肯定判断为SVC起源的PAF。

The purpose of this study is to analysis the electrophysiological characteristic of paroxysmal atrial fibrillation (PAF) originating from pulmonary vein (PV) or superior vena cava (SVC). Evaluate the effectiveness of electrical-isolation of single PV or SVC which triggered PAF. Fourteen patients among ninety consecutive in-patients (male 10,female 4),age51±10(39-64)years old,with frequent drug refractory daily paroxysmal symptomatic atrial fibrillation,were involved in the study from August 2001 to May 2003. Activation mapping was performed in lateral right atrium,right superior PV,left superior PV,left inferior PV or SVC. Electrical isolation was performed in PV or SVC that triggered PAF. Results: Single one PV/SVC triggered PAF was successfully electrical-isolated in all 14 patients. PAF reoccurred in 5 patients. 3 patients among the five patients accepted second electrophysiology study and more PVs that triggered PAF were founded and successfully electro-isolation was given. During 314.6±214.9 days following-up,11 patients were symptom free without anti-arrhythmias medicine. There was no PAF recurrence in the five patients who accepted SVC electrical isolation. Conclusion: Electro-isolation of SVC that triggered PAF without PV electro-isolation could lead a high success rate. Single PV electro-isolation can only partly radically eliminated PAF.