摘要:
目的:总结三维标测系统指引下环肺静脉前庭电隔离消融治疗阵发性心房颤动（房颤）的单中心经验。方法:入选接受导管消融治疗的阵发性房颤患者190例为研究对象,在Carto系统指引下进行环肺静脉前庭电隔离消融,消融径线位于肺静脉开口外15～20mm,消融终点为心房-肺静脉间电传导完全阻滞,双侧隔离后观察30min。酌情增加心房其他部位消融。术后通过ECG和Holter评估消融效果。结果:所有患者手术顺利完成,术中及术后无严重并发症,均达到了双侧肺静脉完全电隔离。182例完成术后随访,失访8例,平均随访（15.8±6.4）个月;复发22例（经过3个月的空白期）,有14例进行了二次消融,其中12例未再复发。一次手术后88%无复发,二次以上手术94.5%无复发。结论:以环肺静脉前庭电隔离消融为基本术式治疗阵发性房颤可取得满意疗效,适当扩大环形消融范围、确保心房-肺静脉间电传导完全阻滞及延长消融后观察时间均有助于提高手术成功率。
Abstract:
Objective:To summarize initial experience of three-dimensional mapping system guided circumferential pulmonary vein antral isolation（PVAI） in treating patients with paroxysmal atrial fibrillation（PAF）.Method:190 consecutive patients with PAF who underwent PVAI procedure were analyzed.As the basic operation,the PVAI was guided by Carto,and the ablation lines were located within 15-20 mm outside the PV ostium.The end point was electric conduction block between atria and pulmonary vein completely,and there was 30 min of observation time post-ablation.The other sites of atria were ablated if needed.ECG and Holter monitors were used to evaluate the clinical effectiveness of ablation.Result:All operations were completed successfully without serious complications.The ablation endpoint were achieved in all patients.The follow-up were smoothly implemented in 182 patients.During a mean follow-up of（15.8±6.4） months,22 patients experienced late recurrences after three months washout period,14 patients received re-ablation and 12 of them without recurrences.160 of 182（88%） patients remained in sinus rhythm after a single procedure,including repeat procedures,172 of 182（94.5%） patients remained in sinus rhythm.Conclusion:The circumferential PVAI ablation as the basic operation is safe and effective for PAF therapy.Enlarging scope of circumferential PVAI ablation properly,securing electric conduction block between atria and pulmonary vein completely,and extending observation time could all contributed to the improvement in the success rate of ablation for PAF.
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