摘要
目的评价阵发性心房颤动(房颤)导管消融术后早期复发的电生理机制及早期再消融的可行性、疗效。方法入选环肺静脉电隔离术后1个月内复发的阵发性房颤患者14例,其中男8例,女6例,平均年龄61.8±8.4岁,房颤复发距首次消融时间4.9±3.7 d。若肺静脉传导恢复,则补点消融再次隔离。肺静脉隔离后诱发房颤,标测并消融非肺静脉异位灶。术后随访心电图和24 h动态心电图。结果14例患者首次消融后24.7±5.5 d再次消融。仅1例肺静脉传导无恢复,其余13例(92.9%)中均有至少一侧肺静脉传导恢复,补点消融后均再次隔离。3例(21.4%)为上腔静脉起源房颤,行上腔静脉隔离房颤终止。1例(7.1%)为界嵴上部起源,行局灶消融成功。3例诱发出典型心房扑动(房扑),1例诱发出左心房房扑,消融均成功。术后平均随访5.8±1.4个月,13例患者无房性快速性心律失常复发(不用抗心律失常药物),1例有阵发性房速发作(服用维拉帕米)。结论肺静脉传导恢复是阵发性房颤消融术后早期复发的主要因素,其次是非肺静脉(上腔静脉、界嵴)的异位灶,早期再消融可行有效。
Objective To evaluate the electrophysiological mechanism of early recurrence of atrial tachyarrhythmias （ATa） after initial ablation for paroxysmal atrial fibrillation （AF）and the feasibility of early re-ablation. Methods Forteen cases （ 8 males, average age of 61.8 ± 8.4 years） presented with early reeurrent ATa within 1 month after initial ablation were included. Early recurrence was observed after a mean of 4. 9 ± 3.7 days post-ablation. During re-ablation, all pulmonary vein （PV） reconnection was re-isolated, and AF induction was applied to map and ablate non-PV triggers. ECG and Hoher monitor was applied to evaluate the effect Results Re-ablation was performed after a mean follow-up of 24. 7 ± 5.5 days after the first ablation. PV re-connection was identified in 13 cases （92.9%） and was re-isolated by closing eonduetion gaps along initial lesion lines. By AF induction, superior vena eava （ SVC ） originated AF was detected in 3 cases and was terminated by SVC isolation. Upper erista terminalis （CT） foci was found in 1 case whieh was eliminated by focal ablation. Typical atrial flutter （AFL） in 3 cases and left atrial AFL in 1 case were terminated by linear ablation. At the end of follow-up of 5.8 ± 1.4 months, 13 cases were free from ATa recurrence and anti-arrhythmie drugs. Paroxymal ATa was observed in 1 case which could be suppressed by veraparnil. Conclusion PV re-connection is the main influencing factor of early recurrenee of ATa after initial ablation for paroxysmal AF. Other factors include foci located in SVC and CT. Early reablation is feasible and effective.
出处
《中国介入心脏病学杂志》
2008年第5期264-267,共4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
