摘要
目的评价三维标测系统(CARTO或EnSite-NavX)指引导管消融治疗心房颤动(房颤)的总体疗效和安全性。方法2004年9月至2006年12月期间入选800例房颤患者,男性482例,女性318例,平均年龄62.1±15.6(18～82)岁。其中阵发性房颤611例,持续性房颤189例,平均左心房内径38.4±9.2(30～60)mm。采用EnSite-NavX系统260例,CARTO系统540例。对于阵发性房颤采取环肺静脉前庭电隔离,对于持续性房颤采取环肺静脉前庭电隔离+心房碎裂电位消融+二尖瓣峡部消融。术后口服华法林及ⅠC类和Ⅲ类抗心律失常药物1～3个月,每月随访心电图、24小时动态心电图一次。对于术后1个月的房颤或房性心动过速(房速)复发进行再次标测和消融。结果795例完成手术。平均手术时间161±33(140～245)min,X线透视时间17±13(12～45)min。左肺静脉电隔离率为96.5%,右肺静脉电隔离率为98.6%。阵发性房颤术中发作98例,消融终止房颤90例。阵发性房颤术后2周内早期复发137例(22.5%),103例2周后不再发作,共57例接受再次消融(6例接受三次消融)。持续性房颤环肺静脉消融恢复窦性心律30例(16.1%),转变为房速/心房扑动(房扑)15例(8.1%)。心房碎裂电位消融恢复窦性心律20例(10.8%),转变为房速/房扑23例(12.4%)。持续性房颤术后早期复发78例(41.9%),14例随访中不再发作。65例再次消融(10例接受三次消融)。所有病例房颤消融术后房扑/房速104例(13.1%),68例随访中自愈,30例再次消融,23例消融成功。并发症:心脏压塞5例(0.6%,3例内科保守治疗成功,2例外科修补),肺静脉狭窄6例(0.7%),一过性脑缺血(TIA)1例,脑栓塞2例,肠系膜动脉栓塞1例。血胸1例,气胸1例。股动脉假性动脉瘤3例,股动静脉瘘1例。术后平均随访16.2±5.7(3～27)个月,阵发性房颤550例(90.3%)无房性快速性心律失常发作(9.4%再次消融,11.5%口服抗心律失常药物);持续性房颤159例(85.5%)无房性快速心律失常发
Objective To evaluate the safety and effectiveness of catheter ablation for atrial fibrillation （AF） therapy guided by 3-D mapping systems. Methods Eight hundred cases （482 male, mean age 62. 1 ± 15.6 years） were enrolled. AF was paroxysmal in 611 cases, and pemistent in 189 cases. The mean left atrium diameter was 38.4 9. 2 mm. Ablation was guided by EnSite-NavX in 260 cases and by CARTO in 540 cases. Circumferential pulmonary vein isolation （CPVI） was performed for paroxysmal AF, and CPVI combined with complex fractionated atrial electrograms （CFAEs） and mitral isthmus ablation was applied for persistent AF. Every case received oral anticoagulation with warfarin and class IC and class III antiarrhythmic drugs for 1 to 3 months. ECG and Holter were applied every month during follow-up. Results Seven hundred and ninty-five cases underwent the procedure successfully, with the mean procedural time 161 33 rain and fluoroscopic time 17 13 min. PV isolation was achieved in 96. 5% of cases for left-sided PVs, and in 98.6% of cases for right-sided PVs. Radiofrequency application terminated paroxysmal AF in 90 out of 98 cases. AF recurred in 137 cases within 2 weeks post-ablatlon, and subsided in 103 cases during subsequent follow-up. Fifty-seven cases underwent re-ablation and 6 cases required third ablation. Persistent AF was terminated in 30 cases （ 16. 1% ） and was converted to atrial tachycardia in 15 cases （8. 1% ） by CPVI. For patients receiving CFAEs ablation, persistent AF was terminated in 20 cases （10. 8% ） and was converted to atrial tachycardia in 23 cases （ 12.4% ）. AF recurred in 78 cases （41.9%） early after ablation and 65 cases underwent re-ablation （ 10 cases received third ablation）. Atrial tachycardia/flutter developed in 104 cases （13.1% ） after ablation, and remitted in 68 cases. Atrial tachycardia/flutter was mapped and ablated in 30 cases, and was eliminated in 23 cases. Complications： Cardiac tamponade developed in 5 cases, requiring pericardiocente
出处
《中国介入心脏病学杂志》
2007年第3期128-132,共5页
Chinese Journal of Interventional Cardiology
关键词
心房颤动
肺静脉
导管消融术
Atrial fibrillation
Pulmonary vein
Catheter ablation
