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目的 对心房-肺静脉(或上腔静脉)射频消融电隔离(电隔离)术后随访2～12(6.53±4.10)个月内的心房颤动(房颤)复发病例进行再次心内电生理检查及射频消融治疗,探讨电隔离治疗后房颤复发的可能原因,评估再次电隔离的效果。方法 共9例病人,男性8例,女性1例,年龄(53.3±13.2)岁。对上次已作电隔离和上次未进行电隔离的肺静脉和上腔静脉逐一进行标测,对存在心房-静脉传导的静脉进行射频消融心房-静脉电隔离。结果 9例患者上次射频消融电隔离总共22根静脉(19根肺静脉和3根上腔静脉)中,经电生理标测发现其中17根静脉(15根肺静脉和2根上腔静脉)恢复了静脉-心房传导。对这些静脉以及上次未进行电隔离的8根静脉进行射频消融电隔离。术后随访1～15(7.22±5.04)个月,7例病人无房颤复发,2例病人发作次数明显减少。结论 静脉-心房传导恢复及遗留未进行电隔离的大静脉可能是房颤复发的原因,对复发病例,再次射频消融治疗是安全和有效的。
Objective To observe the recurrence of atrial fibrillation (AF) within 2 ~ 12 (6.53 ± 4.10) months after atrial-pulmonary vein (or superior vena cava) radiofrequency ablation (electrical isolation) Radiofrequency ablation treatment to explore the possible reasons for the recurrence of atrial fibrillation after electrical isolation treatment to assess the effect of electrical isolation again. Methods A total of 9 patients, 8 males and 1 females, aged (53.3 ± 13.2) years. Pulmonary venules and superior vena cava, which were last electrically isolated and not electrically isolated, were mapped one-by-one and atrial-venous conduits were radiofrequency ablated atrial-venous electrical isolation. Results Of 9 patients who were electrically isolated from each other for a total of 22 veins (19 pulmonary veins and 3 superior vena cava) by radio-frequency ablation, 17 of them (15 pulmonary veins and 2 superior vena cava) were recovered by electrophysiological mapping. Atrial conduction. The veins and the 8 veins that were not electrically isolated last time were radiofrequency ablated. The patients were followed up for 1-15 (7.22 ± 5.04) months. No recurrence of atrial fibrillation was found in 7 patients, and the number of attacks in 2 patients was significantly decreased. Conclusions The recovery of venous-atrial conduction and the left ventricular remodeling without large electrical isolation may be the causes of recurrence of atrial fibrillation. It is safe and effective for recurrence of radiofrequency ablation in patients with recurrent atrial fibrillation.