何鹏义,木胡牙提,马依彤,汤宝鹏,侯月梅,张燕一

• 1:新疆医科大学第一附属医院心脏中心综合心脏内科

摘要(Abstract)：

目的探讨心房颤动(简称房颤)经导管射频消融治疗的安全性。方法 100例阵发性和8例持续性房颤患者,采用Carto标测构建左房三维电解剖图,行肺静脉造影了解其形态,以环状Lasso电极导管多导联双极记录最早肺静脉电位处(传导方向自左心房至肺静脉)、最早心房电位处(传导方向自肺静脉至左心房)为初步消融靶点,围绕左和右侧肺静脉口线性消融,隔离肺静脉。术中持续抗凝治疗,在房间隔穿刺完成后常规静脉注射普通肝素,以100～140IU/kg弹丸式注射,随后15～18IU.kg-1.h-1静点或弹丸式注射;术前、术后均严格抗凝治疗。结果 108例患者均完成预定的线性消融。术后少量心包积液2例,术后1例出现顽固性呃逆,其他并发症包括严重迷走反射3例,术后房扑3例,一过性ST段抬高1例,血气胸1例,颈部血肿3例,随访(8.5±3.8)月,(6～12)个月,未见其他并发症。结论房颤导管消融治疗总体比较安全。肺静脉造影指导、以低功率(20～30W,50℃),在肺静脉开口部消融对于减少心房穿孔、肺静脉狭窄的发生具有重要作用。手术前常规行经食管超声(TEE)和/或螺旋CT检查排除心房血栓,并在手术前后及术中进行规范抗凝治疗可有效预防手术相关血栓栓塞并发症。

关键词(KeyWords)： 心房颤动;射频消融;并发症

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何鹏义,木胡牙提,马依彤,汤宝鹏,侯月梅,张燕一

参考文献(References)：

• [1]Shah DC,Haissaguerre M,Jais P,et al.Spontaneous initiation of atrial fibrillation by ectopic beats or iginating in the pulmonary veins.N Engl J Med,1998,339:659-666.
• [2]Chen SA,Hsieh MH,Tai CT,et al.Initiation of atrial fibrillation by ectopic beats originating frompulmonary veins:eletropysiologi-cal characteistics,pharmacological responses,and effects of radio-frquencyablation.Circulation,1999,100:1879-1886.
• [3]Cappato R,Calkins H,Chen SA,et al.World wide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation.Circulation,2005,111:1100-1105.
• [4]Jais P,Hocini M,Hsu LF,et al.Technique and results of Line-ar ablation at the mitral isthmus.Circulation,2004,110:2996-3004.
• [5]Ho SY,Sanchez-quintana D,Carbera JA,et al.Anatomy of the left atrium:implications for radiofrequency ablation of atrial fi-brillation.J Cardiovasc Electrophysiol,1999,10:1525-1533
• [6]Douglas L,Packer M,Sam A,et al.Progress in nonpharmco-logic threpay of atrial fibrillation.J of Caediovasc Electrophysiol,2003,14:s296-s309.
• [7]马长生,黄从新,刘新鹏,等.141心房颤动经导管消融治疗的并发症分析.中华心律失常学杂志,2003,7:87-90.
• [8]马长生,董建增,刘旭,等.心房颤动竟导管治疗的并发症及其处理//心房颤动——临床实践与治疗进展.北京:人民卫生出版社,2005:220.
• [9]Natale A,Raviele A,Arentz T,et al.Venice chart internation-al consensusdocumention atrial fibrillation ablation.J Cardiovasc Electrophysiol,2007,18:560.
• [10]Marron K,Wharton J,Sheppard MN,et al.Distrbution morphol-ogy,and neurochemistry of engocardial and epicardial nerve ter-minal arborizations in the human heart.Circulation,1995,92:2343-2351.
• [11]Tsai CF,Chen SA,Tai CTet al.Bezold-Jarisch-Like reflex dur-ing radiofrequency energy Ablation of the pulmonary vein tissues in patients with paroxymal focal atrial fibrillation.J Cardiovasc Electrophysiol,1999,10:27-35.
• [12]Raviele A,Themistoclakis S,Rossillo A,et al.Ratrogenicpost atrial fibrillation ablation left atrialTachycardia/flutter:How to prevent and treat it J Cardiovasc Eletrophysiol,2005,16:298-301.
• [13]Cummings JE,Nassir NF,Schweikert R,et al.A trial flutter following pulmonary vein antrum isolation with radiofrequency en-ergy:linear lesins or repeat isolation.J Cardiovasc Eletrophysiol,2005,16:293-297.
• [14]Gerstenfeld E P,Callans D J,Dixit S,et al.Mechanisms of organ-ized left atrial Tachycardias occurring after pulmonary vein isola-tion.Circulation,2004,110:1351-1357.
• [15]Jais P,Haissaguerre M,Shah DC,et al.Complications of radio-frequency catheter ablation in the pulmonary veins in200consec-utive patients.PACE,2000,23(pt II):299.