摘要
目的 探讨心房颤动 (房颤 )导管消融术中发生肺静脉狭窄的可能原因 ,并随访狭窄患者的临床表现。方法 自 1998年 8月至 2 0 0 3年 12月 ,共对连续 2 0 6例房颤患者施行了肺静脉消融治疗。消融后根据选择性肺静脉造影判定有无狭窄 ,并根据狭窄程度分为轻度狭窄 (<5 0 %直径 )、中度狭窄 (5 0 %～ 75 %直径 )和重度狭窄 (>75 %直径 )。通过多因素分析确定与术中肺静脉狭窄相关的临床因素 ,并对所有狭窄患者进行相关临床表现的随访。结果 总计消融 6 2 2根肺静脉 ,其中 10例(4 9% )患者的 10支 (1 6 % )肺静脉出现狭窄 ,包括重度狭窄 2支 ,轻度和中度狭窄各 4支。Logistic多因素回归分析显示 ,在肺静脉深部放电是房颤导管消融术中发生肺静脉狭窄的独立预测因子 (胜算比OR 1 3;95 %可信区间 :1 0 3～ 1 4 1;P <0 0 5 )。肺静脉狭窄部位距离肺静脉开口平均 (1 2± 0 2 )cm。随访 12～ 5 3(4 2 2± 11 8)个月 ,10例患者均未出现提示肺静脉狭窄的临床症状。术后 6～ 12个月 ,9例 (90 % )患者进行了肺通气 /灌注扫描检查 ,均未见异常 ;7例 (70 % )患者接受了肺静脉磁共振血管造影检查 ,原狭窄部位未见狭窄程度进展或消退。结论 (1)在肺静脉深部放电是导致肺静脉狭窄的重要原因 ;(2 )
Objective To explore the causes and follow up the clinical presentation of pulmonary vein (PV) stenosis resulted from catheter ablation procedure for atrial fibrillation(AF). Methods PV ablation was performed in 206 patients with AF from August 1998 to December 2003. The degree of PV stenosis was divided into severe (>75% diameter reduction), moderate (50%～75% diameter reduction) and mild (<50% diameter reduction) according to selective PV angiograpy. Logistic multivariate regression analysis was performed to determine the clinical predictors of PV stenosis. Clinical presentation related to PV stenosis was monitored in all patients with PV stenosis during the follow-up period. Results Of 622 PVs targeted, 10 (1.6%) PV stenosis were detected in 10 (4.9%) patients. Severe, moderate and mild PV stenosis occurred in 2, 4 and 4 PVs, respectively. Delivering the radiofrequency energy within the PV was the only independent predictor for PV stenosis (OR 1.3; 95% CI:1.03～1.41; P<0.05). The distance from the site of stenosis to the ostium of PV was (1.2±0.2) cm. All patients with PV stenosis were asymptomatic during the 12～53 (42.2±11.8) months follow-up. Lung perfusion (V/Q) scans were performed in 9 (90%) patients and showed normal perfusion to the corresponding lung. PV magnetic resonance angiography was performed in 7 (70%) patients, and the regression or progression of diameter reduction was not observed. Conclusions (1)Delivering the radiofrequency energy within the PV is an important risk factor for PV stenosis;(2)Single PV narrowing may not be associated with the development of symptoms.
出处
《中华心律失常学杂志》
2004年第4期207-210,共4页
Chinese Journal of Cardiac Arrhythmias
