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目的探讨三维标测系统指导下行心房颤动(房颤)环肺静脉线性消融的安全性和有效性。方法2003年4月至2006年3月对首都医科大学附属北京安贞医院收治的410例房颤患者进行三维标测系统(CARTO系统或EnSiteNavXTM系统)指导下的环肺静脉线性消融,消融的主要终点为肺静脉电学隔离。随访成功的定义为经3个月的洗脱期无症状性快速性房性心律失常发生。结果394例实现肺静脉电隔离(96%),平均随访(12.4±6.8)个月,阵发性房颤单次消融成功率为77.3%(221/286),持续性、永久性单次房颤消融成功率69.4%(86/124),后者成功率显著低于前者(P=0.006)。103例复发患者中41例接受再次消融,再次消融成功率为75.6%(31/41)。严重并发症包括心脏压塞4例(0.97%),心包穿刺引流后痊愈;脑卒中3例(0.73%),治疗后无肢体运动障碍,日常生活无影响;无死亡病例。结论三维标测指导下心房颤动环肺静脉线性消融是安全、有效的。
Objective To investigate the safety and efficacy of three dimensional (3D) mapping system in guiding the linear ablation of circumferential pulmonary veins in patients with atrial fibrillation (AF). Methods From April 2003 to March 2006, 410 patients with atrial fibrillation undergoing Beijing Ahn Jung Hospital Affiliated to Capital Medical University underwent three-dimensional mapping system (CARTO system or EnSiteNavXTM system) under the guidance of linear ablation of pulmonary vein, the main endpoint of ablation Electrical isolation for the pulmonary veins. Follow-up success was defined as asymptomatic asymptomatic atrial arrhythmia occurring after 3 months of elution. Results 394 cases of pulmonary vein isolation (96%) achieved an average follow-up of (12.4 ± 6.8) months. The success rate of single ablation of paroxysmal atrial fibrillation was 77.3% (221/286). Persistent and permanent atrial fibrillation The success rate of ablation was 69.4% (86/124), the latter was significantly lower than the former (P = 0.006). 41 of the 103 relapsed patients underwent re-ablation and the success rate of re-ablation was 75.6% (31/41). Serious complications included cardiac tamponade in 4 patients (0.97%), pericardiocentesis and drainage, recovery; stroke in 3 cases (0.73%), no limb movement disorders after treatment, no impact on daily life; no deaths. Conclusions Linear ablation of atrial fibrillation and pulmonary vein guided by 3D mapping is safe and effective.