蒋晨曦,马长生,董建增,杜昕,吴嘉慧,龙德勇,喻荣辉,汤日波,桑才华,宁曼,李松南,刘畅

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的分析阵发性心房颤动(房颤)患者肺静脉隔离术后诱发房性心律失常的电生理学特征和长期随访结果。方法连续纳入2010年2月至2010年10月在北京安贞医院心内科行单纯双侧肺静脉电隔离术并行诱发试验的阵发性房颤患者198例。消融后用冠状窦远端快速起搏(周长以250 ms起始直至心房不应期或180 ms)及静点异丙肾上腺素2~4μg/min,诱发房性心律失常持续大于1 min为诱发阳性。诱发出的心动过速以CARTO引导下的激动标测和拖带标测判定机制并进行针对性消融。所有患者术后随访36个月。结果阵发性房颤患者中有39例(19.7%)诱发出共49种房性心动过速(房速),包括35种规则房速和14种房颤。诱发组左心房内径显著大于未诱发组[(39.5±6.6)mm比(36.7±5.2)mm,P=0.004],而年龄、性别、房颤病史、服用抗心律失常药种类、胺碘酮服用史、结构性心脏病比例和左心室射血分数等差异均无统计学意义。诱发出的规则房速中以大折返最为多见,占28例(80.0%)。按诱发心动过速的起源或消融关键部位发生率依次为二尖瓣环峡部(MI)20种(40.8%),三尖瓣环峡部(CTI)12种(24.5%),肺静脉(PV)6种(12.2%,其中右肺静脉2种、左肺静脉4种)、左心房间隔面4种(8.2%)、上腔静脉3种(6.1%)、左心房顶部1种(2.0%)和其他3种(6.1%)通常用线性消融可终止。随访36个月,诱发组和未诱发组成功率差异无统计学意义(63.9%比60.7%,P=0.592)。结论阵发性房颤肺静脉隔离术后以异丙肾上腺素静点+心房快速起搏诱发的心律失常以MI和CTI依赖最为多见,可被针对性线性消融有效终止,且并不增加远期复发率。

关键词(KeyWords)： 阵发性心房颤动;导管消融;诱发

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 蒋晨曦,马长生,董建增,杜昕,吴嘉慧,龙德勇,喻荣辉,汤日波,桑才华,宁曼,李松南,刘畅

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