论文部分内容阅读
目的:探讨肺静脉完全隔离与否对环肺静脉线性消融术治疗阵发性心房颤动(Af)效果的影响。方法:63例阵发性Af患者随机分为隔离肺静脉组(30例)和不隔离肺静脉组(33例)。所有患者均在三维电解剖系统指导下完成环左右肺静脉线性消融。在术前和术后均放置10极环状导管(Lasso)以标测各肺静脉电位情况,对隔离肺静脉组,如环肺静脉消融完成后仍残存肺静脉电位则补充进行节段性肺静脉隔离,而对不隔离肺静脉组环肺静脉消融完成后不作进一步处理。结果:环肺静脉消融完成后,不隔离肺静脉组33例患者中30例(90.9%)未达完全肺静脉隔离。隔离肺静脉组30例患者中26例(86.7%)未达完全肺静脉隔离,在行补充性节段消融后,隔离肺静脉组完全肺静脉电隔离率达96.7%(29/30)。平均随访(11±3)个月后,不隔离肺静脉组81.8%(27/33)的患者和隔离肺静脉组83.3%(25/30)的患者停用抗心律失常药物后无Af发作,2组间差异无统计学意义。结论:环肺静脉线性消融术用于治疗阵发性Af时,术中完全的肺静脉电隔离对于提高长期疗效并非必需。
Objective: To investigate the effect of complete pulmonary vein isolation on the effect of circumferential pulmonary vein ablation on paroxysmal atrial fibrillation (Af). Methods: Sixty-three patients with paroxysmal Af were randomly divided into isolation pulmonary vein group (30 cases) and non-isolation pulmonary vein group (33 cases). All patients under the guidance of three-dimensional electroanatomical system to complete ring around the pulmonary vein linear ablation. Preoperative and postoperative placement of a 10-pole loop catheter (Lasso) to measure the pulmonary venous potential, isolation of the pulmonary vein group, such as circumferential pulmonary vein ablation is still complete after pulmonary vein potential is added segmental pulmonary vein isolation, and Not isolated pulmonary vein group Central pulmonary vein ablation is completed without further treatment. RESULTS: Thirty patients (90.9%) of the 33 patients who did not isolate the pulmonary vein group did not achieve complete pulmonary venous isolation after the circumferential pulmonary vein ablation was completed. Twenty-six patients (86.7%) in the isolated pulmonary vein group did not achieve full pulmonary venous isolation. Complete pulmonary vein isolation rate was 96.7% (29/30) in the isolated pulmonary vein group after supplementary segmental ablation. After a mean follow-up of (11 ± 3) months, no episodes of Af occurred after discontinuation of antiarrhythmic drugs in 81.8% (27/33) of the non-isolated pulmonary vein groups and 83.3% (25/30) of the isolated pulmonary vein groups. There was no significant difference between the two groups. CONCLUSIONS: A circumferential pulmonary vein ablation for the treatment of paroxysmal Af with complete intraoperative pulmonary venous electrical isolation is not necessary to improve long-term outcomes.