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目的评价心外膜环左心房消融(CLAA)联合肺静脉隔离(PVI)治疗心房颤动(AF)的有效性。方法实验用猪30例,体重60~78 kg,应用抽签法随机分为3组:心房颤动对照组(AF组,n=10)、肺静脉消融组(PVI组,n=10)、环左心房消融联合肺静脉消融组(CLAA+PVI组,n=10)。通过心房快速起搏构建持续的AF模型。AF构建成功后,AF组不做消融处理;PVI组应用双极射频消融钳做肺静脉隔离消融;CLAA+PVI组应用双极射频消融钳先做肺静脉隔离消融,再做环左心房消融。消融后,应用电复律将所有AF猪恢复窦性心律,再次检测并比较各组AF易感性及AF维持时间的差异。结果所有猪均经左心房快速起搏成功构建成稳定、持续的AF模型。PVI组和CLAA+PVI组顺利在心脏不停跳下实施心外膜消融术。单纯PVI使3例(15%)终止AF,CLAA+PVI使5例(62.5%)终止AF(P=0.022)。全部猪恢复窦性心律后,burst起搏可使AF组10例全都诱发成持续的AF;PVI组仅有3例(P=0.003)诱发成持续的AF,CLAA+PVI组(P<0.001)无持续的AF诱发成功,均显著低于AF组;而PVI组与CLAA+PVI组差异无统计学意义(P=0.211)。PVI组的房颤平均维持时间较AF组明显缩短(P=0.003);CLAA+PVI组也较AF组明显缩短(P<0.001);与PVI组相比,CLAA+PVI组的房颤平均维持时间也明显缩短(P=0.008)。结论与单纯PVI相比,CLAA+PVI可以更有效终止AF,抑制AF的复发,提高AF的治疗效果。
Objective To evaluate the effectiveness of epicardial left atrial ablation (CLAA) combined with pulmonary vein isolation (PVI) in the treatment of atrial fibrillation (AF). Methods 30 pigs were randomly divided into 3 groups: randomized control group (AF group, n = 10), pulmonary vein ablation group (PVI group, n = 10), left atrium Ablation combined with pulmonary vein ablation group (CLAA + PVI group, n = 10). Continuous atrial pacing through the construction of continuous AF model. After AF was successfully established, the AF group did not ablate. The PVI group was treated with bipolar radiofrequency ablation forceps to isolate and ablate pulmonary veins. The CLAA + PVI group was subjected to isolation and ablation of pulmonary veins with bipolar radiofrequency ablation forceps. After ablation, all AF pigs were restored to sinus rhythm by electrical cardioversion, and the differences of AF susceptibility and AF maintenance time were detected and compared again. Results All pigs were successfully constructed into a stable and continuous AF model by rapid left atrial pacing. The PVI group and CLAA + PVI group successfully performed epicardial ablation under constant cardiac arrest. Three patients (15%) discontinued AF with PVI alone, and five patients (62.5%) terminated AF with CLAA + PVI (P = .022). After all the pigs recovered sinus rhythm, burst pacing induced all 10 AF patients to be continuous AF; only 3 patients in PVI group (P = 0.003) evoked continuous AF, CLAA + PVI group (P <0.001) There was no significant difference between PVI group and CLAA + PVI group (P = 0.211). The average maintenance time of atrial fibrillation in PVI group was significantly shorter than that in AF group (P = 0.003); CLAA + PVI group was also significantly shorter than that in AF group (P <0.001); compared with PVI group, The time was also significantly shorter (P = 0.008). Conclusion Compared with simple PVI, CLAA + PVI can terminate AF more effectively, inhibit the relapse of AF, and improve the therapeutic effect of AF.