王新华,刘旭,施海峰,孙育民,周立,施惠华,顾佳宁,董佳霖

• 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)：

目的评价心房颤动(房颤)初次环肺静脉隔离与再次消融的关键部位分布特点。方法入选48例房颤复发患者,其中男性30例,女性18例;平均年龄54.3±10.2岁;阵发性房颤24例,慢性房颤24例。初次消融采用环肺静脉隔离。再次消融距初次消融时间平均37.2±7.4d。环肺静脉隔离的关键部位为消融时引起肺静脉电位延迟、激动顺序变化或肺静脉电位频率减慢和肺静脉电隔离的部位。将环肺静脉消融线划均分为8个区域,统计初次消融和再次消融关键部位的分布异同。结果48例患者初次消融共有关键部位145个,平均每例患者3.02±1.08个;再次消融共有关键部位76个,平均每例患者1.58±1.09个(P<0.001)。阵发性房颤7例(29.2%)左肺静脉传导未恢复,7例(29.2%)右肺静脉传导未恢复;12例(50%)左肺静脉中再次消融关键部位与初次消融相同者6例,位于初次消融关键部位的相邻节段者6例;8例(33.3%)右肺静脉中再次消融关键部位与初次消融相同者3例,位于初次消融关键部位的相邻节段者5例。慢性房颤9例(37.5%)左肺静脉传导未恢复,11例(45.8%)右肺静脉传导未恢复;10例(41.7%)左肺静脉中再次消融关键部位与初次消融相同者3例,位于初次消融关键部位的相邻节段者7例;5例(20.8%)右肺静脉中再次消融关键部位与初次消融相同者2例,位于初次消融关键部位的相邻节段者3例。结论房颤复发患者再次消融关键部位显著少于初次消融。约30%~40%一侧肺静脉传导未恢复,约20%~50%再次消融关键部位位于初次消融关键部位或其邻近节段。提示对于关键部位及其附近应巩固消融。

关键词(KeyWords)： 心房颤动;导管消融术;肺静脉;复发

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

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