摘要
目的通过随访探讨心房颤动(房颤)射频消融术后近期房性心律失常发作对远期成功率的影响,并探讨发生机制。方法2004年4月至2005年9月共入选52例房颤患者,男性44例,女性8例,年龄24～67(52．6±12．0)岁,病程2-280(35．8±37)个月。其中42例为阵发性房颤,10例为持续性房颤,所有患者均有房颤发作的心电图。13例合并原发性高血压,2例合并房间隔缺损,2例为峡部依赖型心房扑动消融术后,余均无器质性心脏病。所有患者在建立En- Site-NavX左心房几何构型后,于肺静脉口外0．5～1．0 cm处环左侧和右侧肺静脉设置消融线。盐水灌注消融导管于系统导航下沿拟定的消融线逐点消融至肺静脉电位消失。阵发性房颤患者均每日服用普罗帕酮450 mg,培哚普利4 mg,共3个月;持续性房颤患者服用胺碘酮第1周0．6 g／d,第2周O．4g/d,以后0．2g／d,共3个月;培哚普利4 mg／,d,共3个月。结果术后随访6～23 (15．0±5．1)个月。4例因并发症排除;余48例患者,1例术后1个月内发作非典型心房扑动,持续2 d后自行转复窦性心律,随访7个月未有房性心律失常发作。20例患者术后3个月内有阵发性房颤发作,3个月后,12例患者房颤不再发作,余8例随访至6个月,仍有房颤发作。结论心房颤动射频消融术后近期房颤发作者,并不能预测远期房性心律失常发作。术后3个月内有房性心律失常发作而以后不再发作者,可能是心房电学和组织学重构逆转的一个步骤。
Objective To evaluate the effect of atrial tachyarrhythmias after left atrial circumferential ablation （LACA） guided by Ensite-NavX and Lasso technique in the treatment of atrial fibrillation （AF）. Methods Fifty-two patients [ 44 men, 8 women; mean age （52. 6 ± 12. 0） years, range 24 - 67 years ] were included in this study. The mean history of AF of the study group was （ 35. 8 ± 37 ） months （ range 2 - 280 months）. After the geometry of left atrium was reconstructed by Ensite-NavX system, pulmonary veins ostia were marked on the map based on venography. One or two Lasso catheters were placed within the ipsilateral superior and inferior PV. Irrigated radiofrequency energy was applied at 0. 5 - 1.0 cm of distance from PV ostium. Forty- two cases with paroxysmal atrial fibrillation （PAF） and 10 cases with persistent or chronic atrial fibrillation （CAF） obtained the disappearance of PV potential by continuous linear lesion. Patients with CAF were on oral medication of amiodarone and perindpril for three months after the procedure, while patients with PAF were on propafenone and perindpril. Results The endpoint for ablation was reached in 48 patients, the mean follow-up time was （ 15. 0 ± 5. 1 ） months （ range 6 - 23 months）. One patient with AF had clinical occurrence of atypical atrial flutter in the first month; twenty patients had clinical recurrence of AF in the first three months after the procedure,and 12 of which were free of AF occurrence three months after ablation. Conclusions Although there was acute recurrence of AF after left atrium linear lension encircling PV,it can not predict long-term recurrence of AF. The mechanism responsible for this might be the reversal remodeling of the atrium and this process needs a period of time.
出处
《中华心律失常学杂志》
2006年第6期419-422,共4页
Chinese Journal of Cardiac Arrhythmias
基金
卫生部课题(WKJ2004-2-004)江苏省自然科学基金资助(BK2005218)
关键词
心房颤动
导管消融术
肺静脉
重构逆转
Atrial fibrillation
Catheter ablation
Pulmonary veins
Reversal remodel
