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目的:评估重复消融对阵发性心房颤动复发患者的远期获益。方法:入选2000-01-2004-12期间经导管消融(肺静脉电隔离)的阵发性心房颤动患者106例。所有患者心房颤动的症状明显,超过2种抗心律失常药物治疗无效。结果:106例中,失访9例(8.5%),非心源性死亡3例,2次消融时出现一过性脑梗死未完成完整术式1例,其余93例均纳入随访,平均随访5年。1次消融远期维持窦性心律39例,成功率为41.9%。复发者54例中39例(72.2%)进行2次消融,其中27例(69.2%)远期维持窦性心律,消融远期成功率提高了29.0%;复发者12例中5例(41.7%)进行3次消融,其中2例(40.0%)远期维持窦性心律,使远期成功率再提高2.2%;复发者3例中2例(66.7%)再行4次消融,术后均再次复发心房颤动。重复消融累计远期成功率较1次消融明显提高(73.1%∶41.9%,P<0.01)。包括重复消融在内,12个月内的总成功率为81.7%,平均远期复发时间是术后(28.4±8.3)个月。1次消融因电隔离肺静脉电传导恢复导致心房颤动远期复发(6例),经重复消融均可实现远期维持窦性心律。结论:远期复发心房颤动的主要机制是电隔离肺静脉的电传导恢复,重复消融有望实现和维持远期窦性心律。
PURPOSE: To assess the long-term benefit of repeated ablation in patients with recurrent paroxysmal atrial fibrillation. Methods: A total of 106 patients with paroxysmal atrial fibrillation undergoing catheter ablation (pulmonary vein isolation) between 2000-01 and 2004-12 were enrolled. All patients had obvious symptoms of atrial fibrillation and more than 2 antiarrhythmic drugs were ineffective. Results: In 106 cases, 9 cases (8.5%) were lost to follow-up and 3 cases were noncardiac death. One case of incomplete cerebral infarction occurred during 2 ablation and the remaining 93 cases were included in the follow-up, mean follow-up 5 years. Long-term maintenance of sinus rhythm in 39 patients with 1 ablation, the success rate was 41.9%. Of the 54 relapsed patients, 39 cases (72.2%) underwent 2 ablations. Among them, 27 cases (69.2%) maintained sinus rhythm in the long term, the long-term success rate of ablation increased by 29.0%, 5 cases (41.7% ), 3 of them were ablated. Among them, 2 cases (40.0%) maintained long-term sinus rhythm, and the long-term success rate increased by 2.2%. Among the 3 cases relapsed, 2 cases (66.7% Recurrence of atrial fibrillation. The cumulative long-term success rate of repeated ablation was significantly higher than that of primary ablation (73.1% vs 41.9%, P <0.01). Including repeat ablation, the total success rate within 12 months was 81.7%, and the average long-term recurrence time was 28.4 ± 8.3 months after surgery. One-time ablation of electrical isolation of pulmonary veins leads to a long-term recurrence of atrial fibrillation (6 cases), and repeated ablation can achieve long-term maintenance of sinus rhythm. CONCLUSION: The main mechanism of long-term recurrence of atrial fibrillation is electrical conduction recovery of electrically isolated pulmonary veins. Repeated ablation is expected to achieve and maintain long-term sinus rhythm.