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目的:探讨冷盐水导管射频消融肺静脉电隔离术治疗阵发性心房颤动的初步疗效。方法:选择6例阵发性房颤行肺静脉及大静脉电隔离术。常规穿刺成功后做电生理检查同时行房间隔穿刺,用环状电极标测肺静脉的肌袖电位,并确定与心房之间的传导关系。用冷盐水灌注导管消融肺静脉及腔静脉,并于术后服用胺碘酮或普鲁帕酮,连续服用3个月,临床症状减轻且无房颤发生则可停药。结果:6例房颤患者中共隔离肺加上腔静脉22条,左上肺静脉8条,左下肺静脉6条,右上肺静脉4条,右下肺静脉2条,上腔静脉2条,平均每人3.7条。平均随访8个月。术后3个月1例无任何心律失常,2例有间断发作,2例有房性早搏无房颤发生(Holter证实),1例术前持续性房颤术后为间歇发作,3个月后偶发。所有患者术后临床症状都明显减轻甚至无症状。1例发生术中心包填塞,无1例行2次手术。结论:阵发性房颤采用冷盐水导管射频消融电隔离肺静脉对绝大多数患者是有效的,对另一少部分可以减少发作。
OBJECTIVE: To investigate the preliminary effect of cold saline catheter radiofrequency ablation of pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation. Methods: Six patients with paroxysmal atrial fibrillation underwent pulmonary vein and great vein electrical isolation. Routine puncture after the success of electrophysiological examination at the same time atrial septal puncture, pulmonary loop with the electrode labeled pulmonary sleeve muscle potential, and to determine the conduction relationship between the atria. With cold saline infusion catheter ablation of pulmonary veins and vena cava, and after taking amiodarone or propafenone for 3 consecutive months, reduce the clinical symptoms and no atrial fibrillation can be discontinued. Results: In the 6 patients with atrial fibrillation, there were 22 cases of isolated pulmonary vein plus vena cava, 8 left superior pulmonary veins, 6 left pulmonary veins, 4 right superior pulmonary veins, 2 right inferior pulmonary veins and 2 superior vena cava (average 3.7). The average follow-up of 8 months. One patient had no arrhythmia at 3 months after operation, 2 patients had intermittent episodes, 2 had atrial premature beats without atrial fibrillation (Holter confirmed), 1 patient had intermittent episodes of persistent preoperative AF and 3 months After the accident. All patients postoperative clinical symptoms were significantly reduced or even asymptomatic. In 1 case, there was operation center tamponade, none in 2 cases. Conclusion: Paroxysmal atrial fibrillation using cold saline catheter radiofrequency catheter ablation of pulmonary vein isolation for the vast majority of patients is effective, for a small part of the other can reduce the attack.