摘要
目的肺静脉隔离是治疗阵发性心房颤动（房颤）的主要策略。但是部分阵发性房颤患者的房颤为非肺静脉起源。本文对非肺静脉起源阵发性房颤消融效果进行中长期随访研究。方法入选256例阵发性房颤患者，其中女性62例，平均年龄（53±2）岁，行电生理检查，共发现27例（占10．5％）为非肺静脉起源（非肺静脉起源组），包括起源于上腔静脉（16例，占59．3％），左心房后壁（4例，占14．8％），界嵴（2例，占7．4％），冠状静脉窦（2例，占7．4％），卵圆窝（1例，占3．7％），左心耳（1例，占3．7％），左心房游离壁（1例，占3．7％）。其余患者为肺静脉起源组。非肺静脉起源组中，所有病例的触发灶均在初次消融术中成功消融。4例（14．8％）需行2次消融术，其中3例为上腔静脉起源，1例为左心房后壁起源。肺静脉起源组52例（22．7％）需行2次消融术，6例需3次消融术。结果非肺静脉起源组随访（40±12）个月，有25例（92．6％）无房颤复发，肺静脉起源组随访（44±12）个月，185例（80．8％）无房颤复发。结论在房颤某些亚群的治疗中，标测并消融非肺静脉起源的触发灶非常重要。而且对于该类病人，中长期的随访证实中长期成功率较高，提示导管消融治疗房颤有较好的中长期治疗效果。
Objective Pulmonary vein （PV） electrical isolation is the major target of the ablation of atrial fibrillation （AF）. However, Non-PV foci has also been demonstrated to be important in a subtype of AF patients. In this study, we evaluate the medium to long-term successful rate for those AF patients with non-PV loci eliminated. Methods Two hundred and fifty six cases with[ PAF,62 female, mean age（53 ± 2）ys. ] were included. During the electrophysiologic study, twenty-seven patients （10. 5% ） were found with ectopie foci in non-PV areas （Group NPV）, including the superior vena cava （16,59.3%）, left atrial posterial wall （4, 14. 8% ） ,crista terminalis （2,7.4%） ,coronary sinus （2,7.4%） ,fossa ovalis （ 1,3.7% ） ,left atrial appendage （ 1,3.7% ） ,left atrial anterior wall （ 1,3.7% ）. The rest patients were defined as Group PV, though their loci might not originate from PV in some cases. In Group NPV, all the non-PV loci were successfully eliminated during the first procedure. Second procedure was needed in 4 cases （14. 8% ） ,with 3 loci from SVC and one from left atrial posterior wall ,whereas in Group PV 52 cases received second procedure （22. 7% ）. Six cases received the third procedure, but none is from Group NPV. Results During a follow-up period of 40 ± 12 months,the 25 patients from Group NPV were free of PAF recurrence （92. 6% ） ,as compared to 185 without PAF recurrence in Group PV （80. 8% ） after follow-up of （44±12） months. Conclusions Identification and elimination of non-PV foci are important in treatment of a subset of PAF patients. Higher successful rate could be found in the non-PV group as compared to those with PV isolation being routinely performed,which was demonstrated by the medium to long-term follow up.
出处
《中华心律失常学杂志》
2008年第6期412-414,共3页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
消融
肺静脉
Atrial fibrillation
Ablation
Pulmonary vein
