施海峰,刘旭,王新华,顾佳宁,孙育民,周立,胡伟,方唯一

• 1: 上海交通大学附属胸科医院心内科
• 2:上海交通大学附属胸科医院心内科
• 3:上海交通大学附属胸科医院心内科
• 4:上海交通大学附属胸科医院心内科

摘要(Abstract)：

目的比较单纯性环肺静脉前庭电隔离(CPVA)和CPVA结合左房内碎裂电位消融(CFEA)对慢性心房颤动(房颤)治疗的临床疗效。方法2005年4月至2006年7月,对发作频繁、症状严重、药物无效的慢性房颤患者134例(男性77例,女性57例),平均年龄56.8±12.3(38～76)岁,行三维标测系统(CARTO)指导下的房颤导管消融。随机分为两组:CPVA组68例患者行CPVA术,CPVA+CFEA组66例患者在双侧肺静脉前庭电隔离完成后,对左房碎裂电位进行消融。房颤消融术后随访ECG和Holter评价疗效,比较两组的安全性及临床效果。结果两组的基线资料差异无统计学意义,CPVA+CFEA组的平均手术时间增加(185min比147min,P<0.01),但X线透视时间并无明显增加;术后随访6个月时,CPVA组有41例(60%)患者在未服用抗心律失常药物的情况下连续3个月未再发作症状性房性快速性心律失常,而CPVA+CFEA组有51例(77%)达此标准(P<0.05);CPVA组术中出现1例无症状性左上肺静脉狭窄和1例心脏压塞,CPVA+CFEA组有1例气胸,和1例股动脉静脉瘘,无其他重要并发症。结论对于慢性房颤,单纯CPVA的疗效并不理想,合并其他消融策略(如碎裂电位消融)可提高治疗成功率,且并不增加手术风险。

关键词(KeyWords)： 心房颤动;导管消融术;肺静脉;心房

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 施海峰,刘旭,王新华,顾佳宁,孙育民,周立,胡伟,方唯一

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