摘要
目的总结微创房颤术中电生理标测和迷走神经节消融技术的治疗效果。方法2007年9月至2010年5月共185例阵发性心房颤动（房颤）患者接受微创胸腔镜辅助下射频消融术，术前、术后分别标测电生理，标测双向阻滞隔离效果，观察和总结迷走神经节的分布规律。随访记录患者术后窦性心律结果。结果全组微创手术均顺利完成。住院期间无患者死亡，无永久起搏器置人等严重并发症。92％的阵发性房颤患者的肺静脉左心房电位可以被隔离，达到传人和传出双向阻滞。89％的患者为神经节标测阳性，阳性迷走神经节的分布呈一定规律，右肺静脉侧阳性神经节较左侧多。86％的患者迷走神经节分布在肺静脉前庭侧，而非肺静脉口侧。微创射频消融平均需5—6道方可达到肺静脉双向阻滞和去神经化。随访术后3、6、12、24个月的窦性心律分别为83．7％、82．4％、85．4％和83．9％。术后12个月的随访结果显示，消融术中迷走神经节阳性位点多的患者（〉6个）81．3％为窦性心律，而迷走神经节阳性位点较少（≤2个）的患者52．6％为窦性心律。结论术中电生理隔离双向阻滞验证和迷走神经节标测与消融技术可获得良好的远期房颤消融效果。
Objective To conclude the results of electrophysiological （EP） mapping and ganglianated plexis （GPs） ab- lation during the minimally invasive atrial fibrillation （AF） surgery. Methods During the period of Sep 2007 to May 2010 to- tally 185 paroxysmal atrial fibrillation cases were recruited receiving the minimally invasive AF surgery with video assistance. The EP mapping was used to test the dual direction block after ablation and the distribution of GPs was recorded. The sinus rhythm rate was followed up after surgery. Results All the minimally invasive surgery were performed successfully without death in the hospital. There was no permanent pacemaker implant and other serious complications. EP mapping results showed 92% pulmonary vein （PV） potential to the left atrium （LA） could be isolated with the dual direction block for the paroxysmal atrial fibrillation cases. And there were 89% GPs positive, higher rate than the persistent AF. There were more GPs positive in the right PV area than the left and 86% GPs lied at the LA domain, not the PV orifice. At least 5 or 6 ablation lesions were needed to get the dual direction block and denervation of the GPs. The sinus rhythm rate after surgery after 3, 6, 12 and 24 months is 83.7%, 82.4%, 85.4% and 83.9%. The 12 months follow up data showed the cases with more GPs positive （ 〉 6） had 81.3% sinus rate and the less GPs positive （ ≤ 2） group with 52.6%. Conclusion The EP mapping and GPs ablation techniques during the minimally invasive AF ablation surgery could get good sinus rhythm rate during the long term fol- low up.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第4期196-199,203,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
基金项目：省部共建教育部心血管重塑相关疾病重点实验室开放课题（100017031028）
关键词
心房颤动
导管消融术
外科手术
微创性
电生理标测
迷走神经节
Atrial fibrillation Catheter ablation Surgical procedures, minimally invasive Electrophysio-logical mapping Ganglianated plexis
