王新华,刘旭,施海峰,孙育民,周立,施惠华,顾佳宁,董佳霖,王倩

• 1:上海交通大学附属胸科医院心内科

摘要(Abstract)：

目的评价阵发性心房颤动(房颤)导管消融术后早期复发的电生理机制及早期再消融的可行性、疗效。方法入选环肺静脉电隔离术后1个月内复发的阵发性房颤患者14例,其中男8例,女6例,平均年龄61.8±8.4岁,房颤复发距首次消融时间4.9±3.7 d。若肺静脉传导恢复,则补点消融再次隔离。肺静脉隔离后诱发房颤,标测并消融非肺静脉异位灶。术后随访心电图和24 h动态心电图。结果14例患者首次消融后24.7±5.5 d再次消融。仅1例肺静脉传导无恢复,其余13例(92.9%)中均有至少一侧肺静脉传导恢复,补点消融后均再次隔离。3例(21.4%)为上腔静脉起源房颤,行上腔静脉隔离房颤终止。1例(7.1%)为界嵴上部起源,行局灶消融成功。3例诱发出典型心房扑动(房扑),1例诱发出左心房房扑,消融均成功。术后平均随访5.8±1.4个月,13例患者无房性快速性心律失常复发(不用抗心律失常药物),1例有阵发性房速发作(服用维拉帕米)。结论肺静脉传导恢复是阵发性房颤消融术后早期复发的主要因素,其次是非肺静脉(上腔静脉、界嵴)的异位灶,早期再消融可行有效。

关键词(KeyWords)： 心房颤动;肺静脉;导管消融术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王新华,刘旭,施海峰,孙育民,周立,施惠华,顾佳宁,董佳霖,王倩

参考文献(References)：

• [1]Oral H,Scharf C,Chugh A,et al.Catheter ablation for paroxys-mal atrial fibrillation:segmental pulmonary vein ostial ablationversus left atrial ablation.Circulation,2003,108:2355-2360.
• [2]Ouyang F,B nsch D,Ernst S,et al.Complete isolation of theleft atrium surrounding the pulmonary veins:new insights fromthe double Lasso technique in paroxysmal atrial fibrillation.Cir-culation,2004,110:2090-2096.
• [3]Oral H,Knight BP,Ozaydin M,et al.Clinical significance ofearly recurrences of atrial fibrillation after pulmonary vein isola-tion.J Am Coll Cardiol,2002,40:100-104.
• [4]Lee SH,Tai CT,Hsieh MH,et al.Predictors of early and laterecurrence of atrial fibrillation after catheter ablation of paroxys-mal atrial fibrillation.J Interv Card Electrophysiol,2004,10:221-226.
• [5]王新华,刘旭,顾佳宁,等.环肺静脉消融电隔离治疗持续性心房颤动的疗效观察.中国介入心脏病学杂志,2006,14:145-151.
• [6]刘旭,王新华,施海峰,等.三维标测系统指引导管消融治疗心房颤动——单中心800例总结.中国介入心脏病学杂志,2007,15:128-132.
• [7]Ouyang F,Antz M,Ernst S,et al.Recovered pulmonary veinconduction as a dominant factor for recurrent atrial tachycardiasafter complete circular isolation of the pulmonary veins:lessonsfrom double Lasso technique.Circulation,2005,111:127-135.
• [8]Verma A,Kilicaslan F,Pisano E,et al.Response of atrial fi-brillation to pulmonary vein antrum isolation is directly related toresumption and delay of pulmonary vein conduction.Circulation,2005,112:627.
• [9]Daoud EG,Weiss R,Augostini R,et al.Proarrhythmia of cir-cumferential left Atrial lesions for management of atrial fibrilla-tion.J Cardiovasc Electrophysiol,2006,17:157-165.
• [10]Hsieh MH,Chiou CW,Wen ZC,et al.Alterations of heart ratevariability after radiofrequency catheter ablation of focal atrial fi-brillation originating from pulmonary veins.Circulation,1999,100:2237-2243.
• [11]Taylor GW,Kay GN,Zheng X,et al.Pathological effects of ex-tensive radiofrequency energy applications in the pulmonary veinsin dogs.Circulation,2000,101:1736-1742.
• [12]Cheema A,Dong J,Dalal D,et al.Incidence and time course ofearly recovery of pulmonary vein conduction after catheter ablationof atrial fibrillation.J Cardiovasc Electrophysiol,2007,18:387-391.
• [13]O Donnell D,Furniss SS,Dunuwille A,et al.Delayed cure de-spite early recurrence after pulmonary vein isolation for atrial fi-brillation.Am J Cardiol,2003,91:83-85.
• [14]Vasamreddy CR,Lickfett L,Jayam VK,et al.Predictors of re-currence following catheter ablation of atrial fibrillation using anirrigated-tip ablation catheter.J CardiovascElectrophysiol,2004,15:692-697.
• [15]Mainigi SK,Sauer WH,Cooper JM,et al.Incidence and pre-dictors of very late recurrence of atrial fibrillation after ablation.JCardiovasc Electrophysiol,2007,18:69-74.