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风湿性瓣膜病合并心房颤动的导管消融治疗 被引量:2

Catheter ablation of atrial fibrillation in patients with rheumatic valvular disease
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摘要 目的评价风湿性瓣膜病合并心房颤动(房颤)经导管射频消融的安全性和疗效。方法57例风湿性瓣膜病合并房颤患者,其中男性34例,女性23例,年龄39 ̄65岁,平均年龄47.6岁(标准差16.7岁),轻度二尖瓣狭窄4例,二尖瓣球囊扩张术后2例,二尖瓣置换术后17例,二尖瓣、主动脉瓣置换术后34例(其中8例同时行三尖瓣成形术),左心房内径(45.6±7.1)mm,阵发性房颤3例,持续性房颤54例,房颤病程(2.1±1.7)年。术前均经食管超声心动图排除左心房血栓。采用CARTO三维系统引导环肺静脉消融电隔离术,附加二尖瓣峡部、三尖瓣峡部线性消融及左心房碎裂电位消融以改良基质。术后定期随访Holter、ECG及UCG。结果57例患者均顺利完成消融术。操作时间(184±26)min,X线透视时间(25±14)min。环肺静脉消融使左肺静脉电隔离49例(86.0%)、右肺静脉电隔离52例(91.2%)。其余病例结合肺静脉节段性消融实现电隔离。持续性房颤消融恢复窦性心律9例,其中3例环肺静脉消融终止,6例碎裂电位消融终止;持续性房颤转为不典型房扑4例,消融未能终止,转为典型房扑2例,三尖瓣峡部消融恢复窦性心律。消融结束未恢复窦性心律者,均行直流电复律成功转复。术后1个月1例阵发性房颤和10例持续性房颤因复发再次消融。随访时间(7±4)个月,45例(78.9%)患者维持窦性心律。无明显并发症。结论CARTO系统引导环肺静脉消融电隔离结合基质改良治疗瓣膜性心脏病合并的房颤在有经验的治疗中心安全有效。 Objective To evaluate the efficacy and safety of catheter ablation for atrial fibrillation (AF) in patients with rheumatic valvular disease. Methods A total of 57 cases with rheumatic valvular disease (34 male, 23 female, mean age 47.6 years) were enrolled. Among them there were 4 cases with mild mitral stenosis (MS),2 cases with percutaneous balloon mitral valvuloplasty (PBMV), 17 cases with mitral valve prosthesis implantation ,and 34 cases with mitral and aortic valves prosthesis implantation. The mean diameter of left atrium was (45.6 ±7.1 ) mm and the mean AF history was (2.1± 1.7) years. In these patients AF was paroxysmal in 3 cases and persistent in 54 cases. Thrombus in left atrium was excluded by transesophageal echocardiography. Circumferential pulmonary vein isolation (CPVI) was performed guiding by the CARTO system, combined with linear ablation of mitral and tricuspid isthmus and complex fractionated atrial electrograms (CFAEs) ablation as substrate modification. Hoher and ECG was used to evaluate clinical effect during follow-up. Results Fifty-seven cases performed the procedure successfully. The operation time was (184 ± 26) min ,and the fluoroscopic time was (25 ± 14) min. By circumferential ablation ,pulmonary vein(PV) isolation was achieved in 49 cases for the left PV and in 52 cases for the right PV. Segmental ostial ablation was performed in the rest cases to isolate PV. Radiofrequency application terminated persistent AF in 9 cases. Among them CPVI terminated AF in 3 cases,and CFAEs ablation terminated AF in 6 cases. Persistent AF converted to atypical atrial flutter(AFL) in 4 cases, but ablation failed to abolish. Persistent AF converted to typical AFL in 2 cases, which was terminated by tricuspid isthmus ablation. DC cardioversion was performed to restore sinus rhythm when AF persisted at the end of the procedure. Reablation was performed in 11 cases due to AF recurrence. During a follow-up of (7 ± 4) months,45 (78.9 % ) cases we
出处 《生物医学工程与临床》 CAS 2008年第1期41-44,共4页 Biomedical Engineering and Clinical Medicine
关键词 肺静脉 消融术 风湿性瓣膜病 心房颤动 pulmonary vein ablation rheumatic valvular disease atrial fibrillation
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参考文献8

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二级参考文献10

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