李学奇,董玉梅,张彤,夏洪远,曹雪

• 1:哈尔滨医科大学附属第四医院心内科

摘要(Abstract)：

目的研究联合复杂碎裂电位(comp lex fractionated atrial electrogram s,CFAEs)消融及环肺静脉电隔离(c ircum ferential pu lmonary ve in isolation,CPVI)治疗心房颤动(atrial fibrillation,AF)的有效性及安全性。方法持续性AF患者36例,首先进行环肺静脉消融,然后进行左房CFAEs消融,消融中恢复窦性心律则予以诱发AF;结束CFAEs消融未恢复窦性心律者进行电复律。结果 36例患者完成CPVI及CFAEs消融,5例恢复窦性心律;4例于消融中转为房扑;27例患者完成左房CFAEs消融后仍为房颤节律,31例患者进行了电复律,2例患者电复律失败继续进行了线性消融。平均随访12±2个月,CFAEs+CPVI组32例患者一次手术成功率67.6%。结论联合CFAEs+CPVI治疗持续性心房颤动是有效的。

关键词(KeyWords)： 心房颤动;导管消融术

Abstract:

Keywords:

基金项目(Foundation): 黑龙江省教育厅科学技术研究项目(10551149)

作者(Author): 李学奇,董玉梅,张彤,夏洪远,曹雪

参考文献(References)：

• [1]Oral H,Knighgt BP,Ozaydin M,et al.Pulmonary vein isolationfor paroxysmal and persistent atrial fibrillation.Circulation,2002,105:1077-1081.
• [2]Pappone C,Santinelli V,Manguso F,et al.Pulmonary veindenerva tion enhances long-term benefit after circumfere-ntialablation for paroxysmal atrial fibrillation.Circulation,2004,109:327-334.
• [3]Nademanee K,McKenzie J,Kosar E,et al.A new approach forcatheter ablation of atrial fibrillation:Mapping of theelectrophysiologic substrate.J Am Coll Cardiol,2004,43:2044-2053.
• [4]Oral H,Chugh A,Good E,et al.Radiofrequency catheter ablationof chronic atrial fibrillation guided by complex electrograms.Circulation,2007,115:2606-2612.
• [5]Schmitt C,Estner H,Hecher B,et al.Radiofrequency ablation ofcomplex fractionated atrial electrograms(CFAE):Preferentialsites of acute termination and regularization in paroxysmal andpersistent atrial fibrillation.J Cardiovasc Electrophysiol,2007,18:1039-1046.
• [6]Ha ssaguerre M,Ja s P,Shah DC,et al.Clémenty J.Catheterablation of chronic atrial fibrillation targeting the reinitiatingtriggers.J Cardiovasc Electrophysiol,2000,11:2-10.
• [7]Ouyang F,Bansch D,Ernst S,et al.Complete isolation of leftatrium surrounding the pulmonary veins:new insights from thedouble-lasso technique in paroxysmal atrail fibrillation.Circulation,2004,110:2090-2096.
• [8]Konings KTS,Kirchhof CJHJ,Smeets JRLM,et al.High-densitymapping of electrically induced atrial fibrillation in humans.Circulation,1994,89:1665-1680.
• [9]Morillo CA,Klein GJ,Jones DL,et al.Chronic rapid atrialpacing.Structural,functional,and electrophysiologicalcharacteristics of a new model of sustained atrial fibrillation.Circulation,1995,91:1588-1595.
• [10]Verma A,Patel D,Famy T,Martin DO,et al.Efficacy of adjuvantanterior left atrial ablation during intracardiac echocardiography-guided pulmonary vein antrum isolation for atrial fibrillation.JCardiovasc Electrophysiol,2007,18:151-156.
• [11]Estner HL,Hessling G,Ndrepepa G,et al.Electrogram guidedsubstrate ablation with or without pulmonary vein iaolation inpatients with persistent atrial fibrillation.Europace,2008,10:1281-1287.
• [12]Takahashi Y,O′Neill MD,Hocini M,et al.Characterization ofelectrograms associated with termination of chronic atrialfibrillation by catheter ablation.J Am Coll Cardiol,2008,51:1003-1010.
• [13]Park JH,Pak HN,Kim SK,et al.Electrophy siologiccharacteristics of complex fractionated atrial electrograms inpatients with atrial fibrillation.J Cardiovasc Electrophysiol,2009,20:266-272.
• [14]Verma A,Mantovan R,Macle L,et al.Substrate and TriggerAblation for Reduction of Atrial Fibrillation(STAR AF):arandomized,multicentre,international trial.Eur Heart J,2010,31:1344-1356.