CAJ | 학술논문

目的探讨针对阵发性心房颤动(房颤)触发电位进行个体化导管消融的临床效果.方法入选自2010年1月1日至2013年5月31日在北京协和医院心内科首次接受导管消融治疗的阵发性房颤患者,分析首次接受导管消融的阵发性房颤患者.术前接受多次12导联心电图和/或24h动态心电图检查.通过诱发房颤的房性早搏P波形态预判房颤触发电位起源,消融术中环状导管在自发或诱发房颤时标测到预判起源的肺静脉或腔静脉存在提前电位,则认为房颤触发电位明确.房颤触发电位明确的患者采用简化消融策略(个体化消融组),其余患者接受标准环双侧肺静脉前庭电隔离术(标准消融组).全部患者每隔3个月于房颤门诊随访.结果共81例患者[起病年龄(59.2±11.3)岁],23例(女11例)接受个体化导管消融.触发电位起源于左侧肺静脉与右侧肺静脉分别为13例与6例,2例来自上腔静脉,1例来自右侧肺静脉及上腔静脉,1例来自左侧肺静脉及上腔静脉.两组患者手术及X线曝光时间分别为(72.6±10.2)min对(97.6±24.0)min,P=0.001与(21.7±4.2)min对(28.3±10.0)min,P=0.029.平均随访(495.7±187.8)d,个体化消融组患者16例(69.6％)和标准消融组30例(51.7％)首次消融后无房颤/房性心动过速/心房扑动复发,两组窦性心律生存率差异无统计学意义(P=0.167).结论体表和心内电图指导下的个体化导管消融治疗阵发性房颤的临床效果至少与标准导管消融相当,而手术及X线曝光时间较短.
목적 탐토침대진발성심방전동(방전)촉발전위진행개체화도관소융적림상효과.방법 입선자2010년1월1일지2013년5월31일재북경협화의원심내과수차접수도관소융치료적진발성방전환자,분석수차접수도관소융적진발성방전환자.술전접수다차12도련심전도화/혹24h동태심전도검사.통과유발방전적방성조박P파형태예판방전촉발전위기원,소융술중배상도관재자발혹유발방전시표측도예판기원적폐정맥혹강정맥존재제전전위,칙인위방전촉발전위명학.방전촉발전위명학적환자채용간화소융책략(개체화소융조),기여환자접수표준배쌍측폐정맥전정전격리술(표준소융조).전부환자매격3개월우방전문진수방.결과 공81례환자[기병년령(59.2±11.3)세],23례(녀11례)접수개체화도관소융.촉발전위기원우좌측폐정맥여우측폐정맥분별위13례여6례,2례래자상강정맥,1례래자우측폐정맥급상강정맥,1례래자좌측폐정맥급상강정맥.량조환자수술급X선폭광시간분별위(72.6±10.2)min대(97.6±24.0)min,P=0.001여(21.7±4.2)min대(28.3±10.0)min,P=0.029.평균수방(495.7±187.8)d,개체화소융조환자16례(69.6％)화표준소융조30례(51.7％)수차소융후무방전/방성심동과속/심방복동복발,량조두성심률생존솔차이무통계학의의(P=0.167).결론 체표화심내전도지도하적개체화도관소융치료진발성방전적림상효과지소여표준도관소융상당,이수술급X선폭광시간교단.
Objective To investigate the clinical outcomes of individualized catheter ablation strategy targeting trigger potentials in patients with paroxysmal atrial fibrillation(PAF).Methods Data of patients with PAF for first catheter ablation were analyzed retrospectively.Repeated 12-Leads electrocardiography(ECG) and/or 24 hours ambulatory (Holter)ECG were performed before ablation procedure.Triggers of atrial fibrillations were determined by P wave morphology of premature atrial contraction(PAC) initiating PAF and were confirmed if the earliest potentials could be recorded by the deca-polar ring(LASSO) catheter from the prejudged pulmonary veins(PV) or venae cava during spontaneous or isoprenaline induced PAF.A simplified ablation strategy was performed to patients with identified triggers resulting in PAF(individualized ablation group),i.e.circumferential ablation was only performed on the same side of pulmonary veins or venae cava containing the trigger potentials.Other patients without identified triggers underwent standard circumferential pulmonary veins isolation(CPⅥ) (standard ablation group)as control.All patients were followed-up in atrial fibrillation clinic at an interval of every 3 months.Results Eighty-one patients(59.2±11.3 years old) were enrolled.Individualized catheter ablation strategy was performed on 23 patients(11 females).The triggers were determined from left PV in 13 cases,right PV in 6 cases,superior venae cava in 2 cases,both right PV and superior venae cava in 1 case,both left PV and superior venae cava in 1 case.Procedure and fluoroscopy time were(72.6± 10.2) minutes vs.(97.6±24.0) minutes (P =0.001) and (21.7±4.2) minutes vs.(28.3 ± 10.0) minutes (P =0.029),respectively.During a mean follow-up period of(495.7± 187.8)days,16 patients(69.6％)in individualized ablation group and 30 patients(51.7％)in standard ablation group were free from atrial arrhythmias(P=0.167)after the first ablation procedure.Conclusion The clinical outcomes of individualized catheter ablation strategy under the guidance of surface and intracardiac electrogram might be at least equivalent to standard CPVI strategy with significantly shorter procedure and fluoroscopy time.