经导管射频消融治疗房颤临床疗效和安全性分析.docVIP

经导管射频消融治疗房颤临床疗效和安全性分析 　　【中图分类号】R541.7 【文献标识码】A 【文章编号】1672－3783(2011)06－0286－02 　　【摘要】目的 评价经导管射频消融治疗房颤的临床疗效和安全性。方法 68例房颤患者接受三维标测系统（Carto XP或EnSite 3000）指导下经导管射频消融治疗，其中阵发性房颤49例，持续性房颤19例。49例阵发性房颤行环肺静脉前庭隔离术，消融终点为双侧肺静脉完全电隔离，持续性房颤在行环肺静脉前庭隔离术基础上再行碎裂电位消融，必要时加线性消融致双向阻滞。结果 68例患者术后即刻均成功达到消融终点，手术过程中无并发症发生。术后有8例出现了房性心律失常，其中4例为持续性房颤转为阵发性房颤，2例3个月后再次行导管消融获得成功，另2例拒绝再次手术，予口服胺碘酮控制心率；4例阵发性房颤发作频率明显减少、口服胺碘酮可维持窦性心律。其余60例患者均无房颤复发。所有患者术后随访中均未发现与导管消融有关的并发症。结论 经导管射频消融术治疗房颤安全有效。 　　【关键词】心房颤动；电生理学技术，心脏；导管消融术 　　Clinical effect and safety of catheter ablation for atrial fibrillation 　　【Abstract】Objective To investigate the effect and safety of catheter ablation for atrial fibrillation(AF). Methods 68 cases were included in this study, with 49 cases of paroxysmal AF and 19 cases of persistent AF．Radiofrequency ablation guided by three dimensional electroanatomical system（Carto XP or EnSite 3000）. Pulmonary vein isolation (PVI) was performed in all cases. The end-point of ablation was complete electro-isolation of pulmonary veins in paroxysmal AF. Complex fractionated atrial electrograms ablation and linear lesions ablation were performed in persistent AF. The end-point of ablation were the disappearance of complex fractionated atrial electrograms and bidirectional block of linear lesions. Results Sixty-eight cases were successfully achieved the end-point after the ablation instantly. No severe complication was found during the procedure. Eight cases developed atrial arrhythmias after ablation. Four patients with persistent AF was converted to paroxysmal, and 2 cases underwent re-ablation successfully in 6 months; the other with paroxysmal AF decreased episode frequency and took amiodarone. Other 60 cases were not recurrence. No complication was found during the follow-up. Conclusion Catheter ablation is safe and effective for treating AF. 　　【Key words】Atrial fibrillation; Electrophysiologic techniques, cardiac; Catheter ablation 　　 　　心房颤动(atrial fibrillation，AF，房颤)系临床上最常见的室上性心动过速。据Framingh