CAJ | 학술논문

目的：评估递进式消融终止持续性心房颤动(房颤)的长期预后以及左心房线性消融的重要性。方法2008年7月至2010年2月共214例持续性房颤患者在武汉亚洲心脏病医院心内科接受射频消融治疗。其中192例持续性房颤患者采取递进式消融术式,按以下顺序进行消融：环肺静脉前庭消融,心房碎裂电位消融,左心房线性消融(顶部线、二尖瓣峡部线或左心房前部线消融)。手术终点为通过单纯消融终止房颤。结果124例患者在首次消融术中采取递进式消融术转复窦性心律。按转复窦性心律前行左心房线性消融的情况分为3组：A组37例,未行左心房线性消融即转为窦性心律；B组48例,转复前行左心房线性消融,但至少有1条消融线未达双向阻滞；C组39例,行左心房线性消融,且所有消融线均达双向阻滞。 A组患者房颤持续时间明显短于B、C组,3组在其余各项临床基线指标上差异无统计学意义。平均随访(36．4±8．7)个月,C组单次消融术成功率(82．1%)显著高于A组(51．4%)和B组(52．1%,P=0．012)。经随访结果证实,消融终止房颤的患者最终行左心房线性消融的比例占84．7%(105/124)。结论在递进式消融终止房颤的患者中,为了长期保持窦性心律,大部分需要行左心房线性消融,且消融线需要达双向阻滞。
목적：평고체진식소융종지지속성심방전동(방전)적장기예후이급좌심방선성소융적중요성。방법2008년7월지2010년2월공214례지속성방전환자재무한아주심장병의원심내과접수사빈소융치료。기중192례지속성방전환자채취체진식소융술식,안이하순서진행소융：배폐정맥전정소융,심방쇄렬전위소융,좌심방선성소융(정부선、이첨판협부선혹좌심방전부선소융)。수술종점위통과단순소융종지방전。결과124례환자재수차소융술중채취체진식소융술전복두성심률。안전복두성심률전행좌심방선성소융적정황분위3조：A조37례,미행좌심방선성소융즉전위두성심률；B조48례,전복전행좌심방선성소융,단지소유1조소융선미체쌍향조체；C조39례,행좌심방선성소융,차소유소융선균체쌍향조체。 A조환자방전지속시간명현단우B、C조,3조재기여각항림상기선지표상차이무통계학의의。평균수방(36．4±8．7)개월,C조단차소융술성공솔(82．1%)현저고우A조(51．4%)화B조(52．1%,P=0．012)。경수방결과증실,소융종지방전적환자최종행좌심방선성소융적비례점84．7%(105/124)。결론재체진식소융종지방전적환자중,위료장기보지두성심률,대부분수요행좌심방선성소융,차소융선수요체쌍향조체。
Objective This study aimed to evaluate the role of left atrial( LA) linear ablation on the long-term efficacy in patients with persistent atrial fibrillation ( AF ) . Methods One hundred and ninty-two consecutive patients underwent catheter ablation of persistent AF using a stepwise approach with the desired procedural endpoint being AF termination. Ablation was performed in such a sequence:circumferential ablation of pulmonary veins,ablation at sites possessing complex fractionated atrial electrograms,linear ablation of the left atrium roof and mitral isthmus( or left atrium anterior line ) . Results Persistent AF was terminated by ab-lation in 124 of 192 consecutive patients. One hundred and twenty-four patients were divided into three groups:those who had not LA linear lesions in terminating AF( group A,37 patients) ,those who had LA linear lesions but bidirectional conduction block of the LA lines not completely achieved(group B,48 patients),and those who had LA linear lesions and bidirectional conduction block of the lines achieved(group C,39 patients). There was no difference in clinical characteristics among three groups except for a shorter duration of AF in group A (P<0. 01). During a mean follow-up of (36. 4±8. 7) months,the rate of atrial arrhythmias after the single pro-cedure was higher in group C(82. 1%) compared with group A(51. 4%) and group B(52. 1%,P=0. 012). AF termination was achieved in 124 patients,of which 105(84. 7%)ultimately accepted LA linear lesions dur-ing the long-term follow-up. Conclusion Persistent AF can be terminated by step-wise ablation,the majority will require electrical blocked left atrial linear lesions for long-term maintenance of sinus rhythm.