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目的评价阵发性心房颤动(房颤)导管消融术后早期复发的电生理机制及早期再消融的可行性、疗效。方法入选环肺静脉电隔离术后1个月内复发的阵发性房颤患者14例,其中男8例,女6例,平均年龄61.8±8.4岁,房颤复发距首次消融时间4.9±3.7 d。若肺静脉传导恢复,则补点消融再次隔离。肺静脉隔离后诱发房颤,标测并消融非肺静脉异位灶。术后随访心电图和24 h动态心电图。结果14例患者首次消融后24.7±5.5 d再次消融。仅1例肺静脉传导无恢复,其余13例(92.9%)中均有至少一侧肺静脉传导恢复,补点消融后均再次隔离。3例(21.4%)为上腔静脉起源房颤,行上腔静脉隔离房颤终止。1例(7.1%)为界嵴上部起源,行局灶消融成功。3例诱发出典型心房扑动(房扑),1例诱发出左心房房扑,消融均成功。术后平均随访5.8±1.4个月,13例患者无房性快速性心律失常复发(不用抗心律失常药物),1例有阵发性房速发作(服用维拉帕米)。结论肺静脉传导恢复是阵发性房颤消融术后早期复发的主要因素,其次是非肺静脉(上腔静脉、界嵴)的异位灶,早期再消融可行有效。
Objective To evaluate the electrophysiological mechanism of early recurrence after paroxysmal atrial fibrillation (AF) catheter ablation and the feasibility and curative effect of early reablation. Methods Fourteen patients with paroxysmal atrial fibrillation who recurred within 1 month after pulmonary vein isolation were enrolled, including 8 males and 6 females, with an average age of 61.8 ± 8.4 years. The recurrence of atrial fibrillation was 4.9 ± 3.7 days . If the pulmonary venous conduction recovery, the point of ablation again isolated. Atrial fibrillation induced by pulmonary vein isolation, mapping and ablation of non-pulmonary venous heterotopic foci. After follow-up electrocardiogram and 24 h Holter. Results 14 patients reabsorbed again 24.7 ± 5.5 days after the first ablation. Only one case of pulmonary vein conduction without recovery, and the remaining 13 cases (92.9%) in at least one side of the pulmonary vein conduction recovery, after filling point ablation are again isolated. Three cases (21.4%) of the origin of atrial fibrillation in the superior vena cava, the superior vena cava isolated atrial fibrillation termination. One case (7.1%) was the origin of the upper crista and the ablation was successful. 3 cases induced typical atrial flutter (atrial flutter), 1 case induced left atrial flutter, ablation were successful. The patients were followed up for an average of 5.8 ± 1.4 months. Thirteen patients had atrial tachyarrhythmia recurrence (without antiarrhythmic drugs) and one had paroxysmal atrial tachycardia (taking verapamil). Conclusions Pulmonary venous conduction recovery is the main factor of early recurrence after paroxysmal atrial fibrillation ablation, followed by ectopic foci of non-pulmonary veins (superior vena cava and border cristae). Early reablation is feasible and effective.