CAJ | 학술논문

目的探讨环肺静脉电隔离(CPVI)术中静脉注射异丙肾上腺素(ISO)和三磷酸腺苷(ATP),在检出阵发性心房颤动(房颤)非肺静脉触发灶中的价值.方法回顾性分析2010年4～ 12月在浙江邵逸夫医院心内科所有患者接受三维标测系统指导下CPVI术136例患者,其中87例消融前后分别应用ISO+ATP诱发房颤,Lasso导管置于右上肺静脉口、消融导管置于左上肺静脉口,结合冠状静脉窦导管判断房颤的触发灶,然后通过消融验证.结果 87例首次接受导管消融的阵发性房颤患者,使用ISO+ATP后16例证实有非肺静脉房颤触发灶.其中,消融前诱发8例房颤、1例房性心动过速(房速)、1例频发房性早搏(房早).2例消融前诱发的患者CPVI术后房性快速性心律失常(ATa)仍存在,余8例及5例消融前未被诱发者CPVI后再次诱发时又检出非肺静脉触发灶.其中,9例为房颤(起源上腔静脉5例、冠状静脉窦内靠近口部1例、左心房后壁2例、不明1例),3例房性心动过速(均为冠状静脉窦口起源)和1例频发房性早搏(上腔静脉起源).14例患者在相应非肺静脉触发灶部位消融后心律失常均终止,且不再被诱发.2例起源不明的房颤患者电复律后转为窦性心律.随访2年,单次手术成功率为87.5％(14/16).结论静脉注射ISO+ATP可简单有效地检出阵发性房颤非肺静脉触发灶.
목적 탐토배폐정맥전격리(CPVI)술중정맥주사이병신상선소(ISO)화삼린산선감(ATP),재검출진발성심방전동(방전)비폐정맥촉발조중적개치.방법 회고성분석2010년4～ 12월재절강소일부의원심내과소유환자접수삼유표측계통지도하CPVI술136례환자,기중87례소융전후분별응용ISO+ATP유발방전,Lasso도관치우우상폐정맥구、소융도관치우좌상폐정맥구,결합관상정맥두도관판단방전적촉발조,연후통과소융험증.결과 87례수차접수도관소융적진발성방전환자,사용ISO+ATP후16예증실유비폐정맥방전촉발조.기중,소융전유발8례방전、1례방성심동과속(방속)、1례빈발방성조박(방조).2례소융전유발적환자CPVI술후방성쾌속성심률실상(ATa)잉존재,여8례급5례소융전미피유발자CPVI후재차유발시우검출비폐정맥촉발조.기중,9례위방전(기원상강정맥5례、관상정맥두내고근구부1례、좌심방후벽2례、불명1례),3례방성심동과속(균위관상정맥두구기원)화1례빈발방성조박(상강정맥기원).14례환자재상응비폐정맥촉발조부위소융후심률실상균종지,차불재피유발.2례기원불명적방전환자전복률후전위두성심률.수방2년,단차수술성공솔위87.5％(14/16).결론 정맥주사ISO+ATP가간단유효지검출진발성방전비폐정맥촉발조.
Objective To evaluate the effectiveness of isoprel and adenosine triphosphate (ISO + ATP) administration in induction of atrial fibrillation from non-pulmonary vein (PV) foci in patients with paroxysmal atrial fibrillation (AF) during circumferential pulmonary vein isolation (CPVI) procedure.Methods Eighty-seven patients underwent CPVI with guidance of three dimensional navigation system.Meanwhile ISO+ATP iv bolus were administrated both before and post CPVI to induce AF.Lasso catheter in the antrum of right superior pulmonary vein,ablation catheter resting on the crina in the antrum of left superior pulmonary vein,with coronary sinus catheter were used to identify the origin of extra-PV foci which was confirmed by further ablation.Results In a cohort of 87 patients who underwent initial catheter ablation therapy,using ISO+ ATP infusion,non-PV AF was totally detected in 16 patients.AF was induced in 8 patients,atrial tachycardia in 1 patient,and frequent premature atrial contraction (PACs) in 1 patient before ablation.Except for 2 patients remained in atrial tachyarrhythmia after CPVI,the rest 8 patients and 5 patients who initially were in sinus rhythm after ISO+ATP injection were induced atrial tachyarrhythmia after repeat administration of ISO+ATP.Nine were in AF (origins were as following:superior vena cava in 5,coronary sinus in 1,left atrial posterior wall in 2,and unknown in 1),3 in atrial tachycardia (all from coronary sinus),and 1 PACs (from superior vena cava).Fourteen patients converted to sinus rhythm after non-PV foci ablation without recurrence when ISO+ATP iv infusion were repeated.The rest 2 patients with unknown origin underwent electrical cardioversion successfully.87.5％ (14/16) patients were recurrence-free during 2 years follow-up.Conclusion ISO+ATP administration is a simple and effective method to reveal AF from non-PV foci in patients with paroxysmal AF during the CPVI procedure.