CAJ | 학술논문

目的研究不同射频导管消融(RFCA)策略治疗阵发性心房颤动(PAF)的临床效果.方法将44例PAF患者分成两组:①肺静脉电隔离组(PVI)21例,应用Ensite3000 Navx系统和Lasso电极指导下进行环肺静脉电隔离.终点消融为:若房颤发生,在消融过程中房颤终止,且肺静脉电位(PVP)消失,或房颤未终止,但PVP消失;若在窦律下消融,PVP消失.②PVI联合左房线性消融(PVI+LALL)组23例,除完成PVI外,进行左心房顶部线和峡部线的消融并达到完全阻滞.结果 ①PVI组21例PAF患者均顺利完成手术,手术时间189～267 min,X线暴光时间24～51 min,17例患者术中出现房颤,其中9例在消融过程中房颤终止且达到肺静脉电隔离,另外8例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.随访期间发现3个月后有67%的患者房颤消失或明显减少.②PVI+LALL组23例PAF患者均顺利完成手术,手术时间234～297 min,X线暴光时间29～55 min,19例患者术中出现房颤,其中14例在消融过程中房颤终止且达到肺静脉电隔离,另外5例消融过程中房颤未终止,但肺静脉完全隔离.4例患者在窦性心律下完成了肺静脉电隔离.左心房顶部线全部达到完全阻滞,峡部线有5例未能达到完全阻滞.随访期间发现3个月后有86.9%的患者房颤消失或明显减少.与PVI组比较,PVI+LALL组手术时间明显延长,房颤消融后的随访成功率明显增加(P＞0.05).结论环肺静脉电学隔离联合左心房线性消融可以明显提高房颤RFCA后的随访成功率.
목적 연구불동사빈도관소융(RFCA)책략치료진발성심방전동(PAF)적림상효과.방법 장44례PAF환자분성량조:①폐정맥전격리조(PVI)21례,응용Ensite3000 Navx계통화Lasso전겁지도하진행배폐정맥전격리.종점소융위:약방전발생,재소융과정중방전종지,차폐정맥전위(PVP)소실,혹방전미종지,단PVP소실;약재두률하소융,PVP소실.②PVI연합좌방선성소융(PVI+LALL)조23례,제완성PVI외,진행좌심방정부선화협부선적소융병체도완전조체.결과 ①PVI조21례PAF환자균순리완성수술,수술시간189～267 min,X선폭광시간24～51 min,17례환자술중출현방전,기중9례재소융과정중방전종지차체도폐정맥전격리,령외8례소융과정중방전미종지,단폐정맥완전격리.4례환자재두성심률하완성료폐정맥전격리.수방기간발현3개월후유67%적환자방전소실혹명현감소.②PVI+LALL조23례PAF환자균순리완성수술,수술시간234～297 min,X선폭광시간29～55 min,19례환자술중출현방전,기중14례재소융과정중방전종지차체도폐정맥전격리,령외5례소융과정중방전미종지,단폐정맥완전격리.4례환자재두성심률하완성료폐정맥전격리.좌심방정부선전부체도완전조체,협부선유5례미능체도완전조체.수방기간발현3개월후유86.9%적환자방전소실혹명현감소.여PVI조비교,PVI+LALL조수술시간명현연장,방전소융후적수방성공솔명현증가(P＞0.05).결론 배폐정맥전학격리연합좌심방선성소융가이명현제고방전RFCA후적수방성공솔.
Objective To study the clinical effect of different radiofrequency catheter ablation (RFCA) method for paroxysmal atrial fibrillation (PAF). Methods Forty-four cases were divided into pulmonary vein isolation group( PVI group,21 cases) and pulmonary vein isolation combined with left atrium linear lesion group( PVI + LALL group, 23cases). PVI group guided by EnSite NavX mapping system, and circle mapping catheter (Lasso). The end point of ablation was pulmonary vein potential disappear. PVI + LALL group were ablated the roofine and the mitral annulas isthmus achieved complete tion completely. The mean procedure time and fluoroscopy time were (227 ± 37) minutes 17 cases occured AF in operation, 9 cases of AF stopped and pulmonary vein were isolated in operation, the other 8cases achieved pulmonary vein isolation although AF didnt stop. 4 cases achieved complete PVI in sinus LALL group all reached the endpoint of ablation completely. The mean procedure time and fluoroscopy time were (277±41) minutes. Nineteen cases occured AF in operation, 14 cases of AF stopped and pulmonary veins were isolated in operation, the other 5 cases achieved PVI although AF didn't stop.Four cases achieved complete PVI in sinus rhythm. The rooflines were completed block. The mitral annulus isthmus were not completed block in 5 cases. During 3 months of follow-up, 86.9% patients were free or obviously decrease of AF. Compared with PVI group, PVI + LALL group procedure time and follow up achievement ratio were obviously increased. Conclusions Circumferential PVI combined with LALL can obviously increase the catheter ablation follow up achievement ratio in PAF patients.