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目的评价射频导管消融电学隔离心脏大静脉预防阵发性心房颤动(房颤)发作的疗效。方法83例患者,男性58例、女性25例,年龄15~76平均(605±185)岁,有阵发性房颤病史2~15年,曾服数种抗心律失常药物疗效不佳。41例患者合并有高血压病,所有患者均无明显器质性心脏病改变。常规行心脏大静脉造影,测量靶静脉直径,将10极肺静脉环状标测导管(Lasso导管)放置在靶静脉开口内05cm处,以Lasso导管为指导,把温控大头电极导管放置于靶静脉开口处行电学隔离。结果83例患者共电学隔离大静脉343条。包括左上肺静脉(LSPV)83条,右上肺静脉(RSPV)83条,左下肺静脉(LIPV)82条,右下肺静脉(RIPV)42条,上腔静脉(SVC)53条,其中2例LSPV与LIPV共同开口。每条肺静脉行1~4段消融(平均每条消融25段),即刻电学隔离成功大静脉337条。随访2~31个月,其中50例停服抗心律失常药物后无房颤发生,13例患者房颤发作明显减少,20例患者房颤发作消融前后无明显变化。并发症有2例术中出现左侧大量胸腔积血,1例心肺复苏5天后出现脑死亡。发现肺静脉狭窄21例,其中轻度狭窄15例,重度狭窄6例,无肺静脉闭塞。结论(1)成功的心脏大静脉电学隔离治疗阵发性房颤的总有效率达到75%左右;(2)由于很难确定靶肺静脉,成功电学隔离各心脏大静脉有可能提高治愈率;(3)此
Objective To evaluate the curative effect of radiofrequency catheter ablation of electrical isolation of cardiac vein to prevent the onset of paroxysmal atrial fibrillation (AF). Methods 83 patients, 58 males and 25 females, aged 15 to 76 (605 ± 185) years of age, with a history of paroxysmal atrial fibrillation 2 to 15 years, had taken several anti-arrhythmic drugs ineffective. 41 patients with hypertension, all patients had no significant organic heart disease changes. Conventional cardiac venous angiography, measuring the diameter of the target vein, the 10-pole pulmonary vein mapping catheter (Lasso catheter) placed in the venous opening 05cm Department, with Lasso catheter as the guide, the temperature control bulk lead placed in the target vein The openings are electrically isolated. Results 83 patients were electrically isolated 343 large veins. Including 83 left superior pulmonary vein (LSPV), 83 right superior pulmonary vein (RSPV), 82 left lower pulmonary vein (LIPV), 42 right lower pulmonary vein (RIPV) and 53 superior vena cava (SVC) Open. Each pulmonary vein ablation 1 to 4 ablation (an average of 25 ablation), the immediate success of electrical isolation of large vein 337. All the patients were followed up for 2 ~ 31 months. Fifty patients stopped atrial fibrillation after taking antiarrhythmic drugs. The incidence of atrial fibrillation was significantly reduced in 13 patients. There was no significant change in 20 patients before and after atrial fibrillation. There were two cases of complications in the left side of a large number of pleural hemorrhage occurred, 1 case of cardiopulmonary resuscitation brain death occurred 5 days later. 21 cases of pulmonary vein stenosis were found, of which 15 cases had mild stenosis, 6 cases had severe stenosis, and no pulmonary vein occlusion. Conclusions (1) The total effective rate of successful cardiac venous isolation in treating paroxysmal atrial fibrillation is about 75%. (2) The successful isolation of cardiac ventricles by electrical isolation may increase the cure rate due to the difficulty of identifying target pulmonary veins. 3) this