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目的探讨三维标测系统指导下环肺静脉消融治疗心房颤动的安全性和有效性。方法阵发性心房颤动92例和持续性或永久性心房颤动36例,接受环肺静脉消融术。采用Carto电解剖标测系统,进行环肺静脉左心房线性消融,消融终点为肺静脉电隔离。手术结束时对心律仍为心房颤动者行同步直流电心脏复律。结果完成“解剖学”环形消融线256条,其中58.6%达到电隔离肺静脉的终点,经寻找缝隙补充消融后最终248条(96.9%)消融线达到终点。手术时间(231±45)min、X线曝光时间(42±13)min和放电时间(66±17)min。术后随访平均10个月,无复发101例(78.9%)。接受了再次手术15例,心内电生理检查证实14例有左心房-肺静脉传导,射频消融成功并随访30～270d,两次射频消融术后总成功率为87.5%,其中阵发性心房颤动成功率为93.0%,持续性或永久性心房颤动为76.7%。并发症发生率为6.2%,包括心包填塞2例、小脑梗死2例、股静脉穿刺部位血肿1例和左侧大量血胸1例,经治疗后均痊愈。结论以肺静脉电隔离为目标的环肺静脉消融术治疗心房颤动有效和安全。
Objective To investigate the safety and effectiveness of circumferential pulmonary vein ablation in the treatment of atrial fibrillation under the guidance of three-dimensional mapping system. Methods A total of 92 patients with paroxysmal atrial fibrillation and 36 patients with persistent or permanent atrial fibrillation received circumferential pulmonary vein ablation. Carto’s electroanatomic mapping system was used to perform linear ablation of the left atrium of the pulmonary veins. The end point of ablation was pulmonary venous isolation. Synchronous DC cardioversion was performed at the end of surgery on those with atrial fibrillation. Results A total of 256 circular ablation lines were completed, of which 58.6% reached the end point of electrically isolated pulmonary veins. The final 248 (96.9%) ablation lines were obtained after finding the gap to be ablated. The operation time (231 ± 45) min, X-ray exposure time (42 ± 13) min and discharge time (66 ± 17) min. The patients were followed up for an average of 10 months without recurrence in 101 cases (78.9%). Fifteen patients underwent reoperation. Cardiac electrophysiological examination confirmed the presence of left atrium-pulmonary venous conduction in 14 patients. Radiofrequency catheter ablation was successful and was followed up for 30 to 270 days. The total success rate after radiofrequency ablation was 87.5%, of which paroxysmal atrial fibrillation The success rate was 93.0%, and persistent or permanent atrial fibrillation was 76.7%. The complication rate was 6.2%, including 2 cases of cardiac tamponade, 2 cases of cerebellar infarction, 1 case of hematoma in femoral vein puncture site and 1 case of massive hemothorax on the left. All patients recovered after treatment. Conclusions Circumferential pulmonary vein ablation for the purpose of electrical isolation of pulmonary veins is effective and safe for the treatment of atrial fibrillation.