CAJ | 학술논문

目的评价EnSite-NavX系统引导下环肺静脉消融电隔离治疗持续性和(或)永久性心房颤动(房颤)的有效性、安全性、术后早期复发房性心律失常的处理及再消融策略.方法入选2007年2月~2012年6月药物治疗无效或不能耐受的持续性/永久性房颤17例,男性15例,女性2例,平均年龄58.4±8.0(44~68)岁,平均房颤持续时间12.7±16.1月(2周~4年),平均左心房内径46.0±6.2(37~55)mm.在EnSite-NavX系统引导下环肺静脉消融达到电隔离,部分患者加左房顶部、左房峡部和三尖瓣峡部线消融.结果17例均顺利完成手术.平均手术时间247.4±67.4(110~350)min,平均X线透视时间39.0±12.5(15~65)min.肺静脉隔离率100%.1例术中房颤终止,16例肺静脉隔离后仍为房颤.16例术中电复律,1例术后第4天电复律.6例术后早期发作房颤/房扑,4例长期维持窦性心律;术后晚期5例复发房性心律失常,2例再次消融成功.术后平均随访11.4±8.1(3.5~28)月,14例(82.4%)无超过30s的房性心律失常发作(包括1例服用胺碘酮、2例第二次手术).单纯肺静脉隔离组(CPVI)11例患者全部手术成功,加线消融组6例患者3例成功.1例急性心包填塞,经心包穿刺引流后痊愈.结论环肺静脉消融电隔离能有效治疗持续性和(或)长期持续性房颤,安全性好.
목적평개EnSite-NavX계통인도하배폐정맥소융전격리치료지속성화(혹)영구성심방전동(방전)적유효성、안전성、술후조기복발방성심률실상적처리급재소융책략.방법입선2007년2월~2012년6월약물치료무효혹불능내수적지속성/영구성방전17례,남성15례,녀성2례,평균년령58.4±8.0(44~68)세,평균방전지속시간12.7±16.1월(2주~4년),평균좌심방내경46.0±6.2(37~55)mm.재EnSite-NavX계통인도하배폐정맥소융체도전격리,부분환자가좌방정부、좌방협부화삼첨판협부선소융.결과17례균순리완성수술.평균수술시간247.4±67.4(110~350)min,평균X선투시시간39.0±12.5(15~65)min.폐정맥격리솔100%.1례술중방전종지,16례폐정맥격리후잉위방전.16례술중전복률,1례술후제4천전복률.6례술후조기발작방전/방복,4례장기유지두성심률;술후만기5례복발방성심률실상,2례재차소융성공.술후평균수방11.4±8.1(3.5~28)월,14례(82.4%)무초과30s적방성심률실상발작(포괄1례복용알전동、2례제이차수술).단순폐정맥격리조(CPVI)11례환자전부수술성공,가선소융조6례환자3례성공.1례급성심포전새,경심포천자인류후전유.결론배폐정맥소융전격리능유효치료지속성화(혹)장기지속성방전,안전성호.
Objective To evaluate the effectiveness and safety of circumferential pulmonary vein(PV) isolation in cases with persistent/permanent atrial fibrillation(AF) and measures in recurrence.Methods Seventeen cases(15 males,mean age 58.4±8.0years) with persistent/permanent AF were enrolled from February 2007 to June 2012.The mean duration of AF was 12.7±16.1months(2 weeks~4 years).The mean left atrium diameter was 46.0±6.2(37~55)mm.Circumferential PV isolation was performed guided by the EnSite-NavX system,combined with linear ablation of the superior-posterior wall of left atrium,mitral isthmus and tricuspid isthmus partially. Results All 17 cases underwent the procedure successfully,with the mean procedural time 247.4±67.4(110~350) min and the mean fluoroscopic time 39.0±12.5(15~65)min.The pulmonary vein isolation rate was 100%.AF was converted to atrial flutter(AFL) in 1 case.Sinus rhythm was restored by cardioversion in 17 cases.AF/AT was documented in 6 cases in the early of post-ablation,which was restored by cardioversion or controlled by amiodarone,and 2 cases maintained sinus rhythm in long term;AF/AT was documented in 5 cases in the later of post-ablation,and 2 of them were abolished by re-ablation.After a mean of 11.4±8.1(3.5~28)months of follow-up,14 cases(82.4%) were free of AF(1 case with anti-arrhythmic drugs and 2 with re-ablation).All 11 cases in the CPVI group were free of AF,and 3 of 6 cases were free in the other group.Acute pericardial tamponade was found in 1 case and was cured after proper treatment.Conclusion Circumferential PV isolation was effective and safe for eliminating persistent/permanent AF.