节段性肺静脉电隔离术后心房颤动早期复发的处理对策Treatment strategy of early recurrence of atrial fibrillation after segmental pulmonary veins isolation in patients with paroxysmal atrial fibrillation
杨俊娟,丁燕生,周菁
摘要(Abstract)：
目的 对比分析阵发性心房颤动 (房颤 ,AF)患者行节段性肺静脉电隔离 (PVI)术后早期复发房颤的不同治疗方法 ,以探讨对早期复发房颤的处理对策。方法 顽固性阵发AF患者 6 6例 ,其中男性 5 0例 ,平均年龄 5 5± 17(35～ 76 )岁。术前部分患者行多层螺旋CT肺静脉血管成像 ,术中先行非选择性或选择性逆行肺静脉造影 ,Lasso环形标测电极导管指导下 ,在肺静脉口逐一标测 4根肺静脉 ,行节段性PVI,并常规标测和消融上腔静脉。消融温度控制在 5 0～ 5 5℃ ,功率 2 5～ 35W。结果 电学隔离肺静脉 2 19根 ,电隔离成功 2 10根 ,即刻成功率 96 %。PVI术后 2周内AF复发 2 6例 ,占39 3%。其中 9例再次行PVI,发现 9根原隔离的PV恢复袖房传导 ,2个左房后游离壁异位兴奋灶。其余 17例患者用抗心律失常药物控制AF发作。随访 10± 6 (4～ 2 4 )月 ,再次行PVI的 9例患者中 5例无AF发作 (成功率 5 5 6 % ) ,17例药物控制者中 6例无AF发作 (成功率 35 3% ) ,P >0 0 5。 4 0例无早期复发AF患者中 34例无AF发作 (成功率 85 % )。总成功率为 6 8 2 % (45 / 6 6 )。术中 1例发生心包压塞 ,术后 1例左上肺静脉狭窄 6 0 %。结论 阵发性房颤患者行节段性PVI术后房颤早期复发在临床上并非罕见 ,但早期复发并不意味着AF治疗的失败
关键词(KeyWords)： 心房颤动;导管消融术;肺静脉
基金项目(Foundation):
作者(Author): 杨俊娟,丁燕生,周菁
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