摘要
目的 以肺静脉电学隔离为终点的心房颤动（房颤）消融术式的疗效难以令人满意。本研究旨在探索规范化的递进式个体化心房基质改良消融术治疗房颤的方法。方法 124例患者（男性96例，女性28例），年龄27-76（53．6±8．7）岁。其中92例为阵发性房颤，32例为持续性／永久性房颤。若无自发房颤则在心房进行持续递增的快速刺激（频率200—600次／min）诱发房颤。均在非接触式标测观察房颤时心房激动情况，将最常激动部位做为房颤基质进行改良消融，并根据消融后重复等电位标测的结果作出递进式调整，直至房颤被终止不再被诱发。结果 在既不隔离肺静脉也不寻求碎裂电位的情况下，87．1％（108／124）的房颤消融转复为窦性心律，其余被转为非典型心房扑动（房扑）或房性心动过速（房速）。可将消融灶分为3种类型，其中以7字形的A型线性消融最关键，71．6％的阵发性房颤可被A型消融终止且不再被诱发，而68．8％的持续性／永久性房颤则需通过B型消融终止。随访（21．6±5．3）个月，90．3％（112／124）的患者不服药亦无房颤发生。其余9．7％（12／124）的患者有顽固性非典型房扑／房速，其中仅1．6％（2／124）的患者伴有阵发性房颤。结论 递进式的心房基质消融术可以将房颤有效地转复为窦性心律，并有满意的远期疗效。此种术式简单易行有望在NavX和Carto标测下复制。
Objective This study was aimed at converting atrial fibrillation （AF） to sinus rhythm （SR） by a stepwise substrate modification guided by noncontact isopotential mapping. Methods One hundred and twenty-four patients （92 with paroxysmal and 32 with persistent/permanent AF） were enrolled in the study. A multiple electrode array catheter was placed in the middle of the left atrium （LA） via the transseptal approach. Continuous incremental stimulation （200 - 600bpm） was applied to induce AF if there was no spontaneous AF. The substrate was determined through observing the isopotentials of the atrium. Radiofrequency ablation at the substrate was applied stepwise under the guidance of repetitive isopotential mapping till AF could no longer be induced. Results AF was demonstrably converted to SR in 87. 1% （108/124） of patients while the rest to atypical atrial flutter （AAFL） or atrial tachycardia （AT）. The ablation lesions could be classified as three types. The type A as ＂7＂ figure jinear ablation converted 71.6% of the paroxysmal and type B converted 68.8% of the persistent/permanent atrial fibrillation. During a （21.6±5.3 ） month follow-up,90. 3% （ 112/ 124） of patients were free of atrial tachyarrhythmias without medication,9.7% （12/124） of patients with refractory AAFL/AT and only 1.6% （2/124） of patients had paroxysmal AF as accompanying to AAFL/AT. Conclusion Based on the preliminary data, stepwise individualized substrate modification provides a simplified protocol to convert atrial fibrillation to sinus rhythm without pulmonary vein isolation and fracture potential ablation. This protocol could be applied with Carto or NavX system.
出处
《中华心律失常学杂志》
2007年第1期7-13,共7页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
基质
导管消融
Atrial fibrillation
Substrate
Catheter ablation
