电生理标测指导下肺静脉电隔离术治疗慢性心房颤动Electrophysiologically guided pulmonary veins isolation for chronic atrial fibrillation
张树龙,王莹琦,高连军,刘少稳,李世军,刘金秋,杨东辉,夏云龙,丛培鑫,林治湖,杨延宗
摘要(Abstract)：
目的 探讨电生理标测指导下的肺静脉电隔离术治疗慢性心房颤动 (房颤 )的可行性。方法 2 0例慢性房颤患者 ,男 14例 ,女 6例 ,年龄 5 6～ 72岁 (平均 6 8± 7岁 ) ;房颤病史 1～ 9年 (平均 3± 7年 ) ,经过至少一次的体外同步心脏电复律 ,房颤均在 30min内复发。电生理标测指导下的肺静脉隔离方法为 :(1)最早激动点指导下消融。肺静脉内的Basket导管记录的心房电活动显示节律较规整 ,激动顺序一致。 (2 )房颤长间歇 (连续记录的最长心房电活动间期 >30 0ms)指导下消融。肺静脉内电位节律紊乱 ,激动顺序不一致 ,房颤长间歇后的第一次心脏搏动的最早激动部位为消融靶点。(3) 3型房颤波指导下的消融。房颤频率快 ,肺静脉内Basket导管记录的电活动激动顺序紊乱 ,部分电极记录的心内电图等电位线消失而不能确定孤立的心房电活动 (3型房颤 ) ,此部位作为消融靶点。在房颤过程中完成 4支肺静脉电隔离后 ,房颤不能自发终止者应用体外同步电复律。重新将Basket导管放入肺静脉 ,仍记录到肺静脉电位者将在窦性心律下完成电隔离。结果 (1)临床结果 :所有患者在肺静脉隔离后成功转复为窦性心律 ,其中 1例患者自行转复为窦性心律 ,2例患者转为心房扑动 ,经右心房峡部消融后转为窦性心律 ,余患者经体外同步电复律?
关键词(KeyWords)： 心房颤动;肺静脉;导管消融
基金项目(Foundation):
作者(Author): 张树龙,王莹琦,高连军,刘少稳,李世军,刘金秋,杨东辉,夏云龙,丛培鑫,林治湖,杨延宗
参考文献(References)：
- 1HaissaguerreM ,JaisP ,ShahDC ,etal.Spontaneousinitiationofatrialfibrillationbyectopicbeatsoriginatinginthepulmonaryveins.NEnglJMed,1998,339:659666.
- 2ChenSA ,HsiehMH ,TaiCT ,etal.Initiationofatrialfibrillationbyectopicbeatsoriginatingfromthepulmonaryveins:electrophysiologiccharacteristics,pharmacologicresponses,andeffectsofradiofrequencyablation.Circulation,1999,100:18791886.
- 3PapponeC ,RosanioS ,OretoG ,etal.Circumferentialradiofrequencyablationofpulmonaryveinostia:anewanatomicapproachforcuringatrialfibrillation.Circulation,2000,102:26192628.
- 4PapponeC ,OretoG ,RosanioS ,etal.Atrialelectroanatomicremodelingaftercircumferentialradiofrequencypulmonaryveinablation:efficacyofananatomicapproachinalargecohortofpatientswithatrialfibrillation.Circulation,2001,104:25392544.
- 5HaissaguerreM ,JaisP ,ShahDC ,etal.Catheterablationofchronicatrialfibrillationtargetingthereinitiatingtriggers.JCardiovascElectrophysiol,2000,11:210.
- 6OralH ,KnightBP ,TadaH ,etal.Pulmonaryveinisolationforparoxysmalandpersistentatrialfibrillation.Circulation,2002,105:10771081.
- 7MacleL ,JaisP ,ScaveeC ,etal.Electrophsiologicallyguidedpulmonaryveinisolationduringsustainedatrialfibrillation.JCardiovascElectrophysiol,2003,14:255260.
- 8WellsJLJr,KarpRB ,KouchoukosNT ,etal.Characterizationofatrialfibrillationinman:studiesfollowingopenheartsurgery.PacingClinElectrophysiol,1978,1:426438.
- 9LauCP ,TseHF .Earlyreinitiationofatrialfibrillationafterelectricaldefibrillation:Anewelectrophysiologicalphenomenon.PacingClinElectrophysiol,2001,24:15811584.
- 10CrijinsHJ,VanNoordJ ,VanGelderIC .Recurrenceofatrialfibrillationandtheneedfornewdefinitions.EurHeartJ ,2001,22:17691771