CAJ | 학술논문

目的研究应用带有微型环肺静脉标测导管(微环导管)的冷冻球囊完成肺静脉电隔离的可行性.方法入选2007年12月至2013年3月在德国心脏中心(柏林)接受导管消融的202例阵发性心房颤动(房颤)患者.1次房间隔穿刺后,将冷冻球囊置入左心房.冷冻球囊中央管中放置1根微环导管,作为“导引钢丝”和肺静脉标测导管.结果电隔离751根肺静脉.其中405根肺静脉(53.9％)在冷冻消融过程中,实时记录到肺静脉电位消失;346根肺静脉(46.1％)在冷冻消融后,回撤微环导管,证实肺静脉电隔离.平均手术时间(131.4±51.7) min,X线曝光时间(23.7±11.3) min.随访33.4(6～63)个月,131例(64.9％)患者无房颤发作.1例患者在隔离右上肺静脉时出现膈神经麻痹,1个月后恢复.结论使用带有标测功能的冷冻球囊进行肺静脉电隔离是有效、可行的.
목적 연구응용대유미형배폐정맥표측도관(미배도관)적냉동구낭완성폐정맥전격리적가행성.방법 입선2007년12월지2013년3월재덕국심장중심(백림)접수도관소융적202례진발성심방전동(방전)환자.1차방간격천자후,장냉동구낭치입좌심방.냉동구낭중앙관중방치1근미배도관,작위“도인강사”화폐정맥표측도관.결과 전격리751근폐정맥.기중405근폐정맥(53.9％)재냉동소융과정중,실시기록도폐정맥전위소실;346근폐정맥(46.1％)재냉동소융후,회철미배도관,증실폐정맥전격리.평균수술시간(131.4±51.7) min,X선폭광시간(23.7±11.3) min.수방33.4(6～63)개월,131례(64.9％)환자무방전발작.1례환자재격리우상폐정맥시출현격신경마비,1개월후회복.결론 사용대유표측공능적냉동구낭진행폐정맥전격리시유효、가행적.
Objective This study aims to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein(PV) potentials during ablation procedures and without interchanging catheters.Methods A total of 202 consecutive patients with paroxysmal atrial fibrillation (AF) were enrolled.A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium.A 6pole mapping catheter with a 0.035-inch shaft diameter was introduced into the PV through the central lumen of the cryoballoon catheter.In addition to the function as a recording device,the mapping catheter was also used as a ‘guide-wire' during the procedure.Results A total of 751 PVs were completely isolated using this novel cryoballoon technique.Isolation was observed in real time in 405 veins(53.9％)during the cryoablation.The remaining 346 veins(46.1％) isolation was confirmed immediately post ablation attempt with the mapping catheter.The mean procedure time was(131.4±51.7) min,and fluoroscopy time was(23.7±11.3) min.At follow-up(33.4 months,range 6-63 months),131 (64.9％) patients were free from AF.There was one occurrence of phrenic nerve palsyduring ablation of a right superior PV,which fully resolved after one month.Conclusion The use of a cryoballoon catheter equipped with a 6-pole micromapping catheter inserted through its central lumen for the purpose of mapping and ablation during PV isolation procedures is both feasible and effective.