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目的:探讨非接触三维标测系统指导下环肺静脉电隔离治疗心房颤动(房颤)的可行性和临床疗效。方法:药物治疗无效或不能耐受的房颤患者25例,采用非接触三维标测系统建立左心房、肺静脉的三维等时电势图和电解剖图,并在距离肺静脉口1~2cm处行环肺静脉及其周围组织电隔离。消融终点为:①完成所有环肺静脉消融径线;②全部肺静脉均达电隔离;③阴性诱发结果。结果:①25例患者均达到消融终点;②手术的总操作时间和X线曝光时间分别为(161.3±23.2)min和(38.0±6.8)min;③随访4~12个月,18例(72.0%)无房颤发作;7例(28.0%)有房颤复发,其中2例因其发作次数及时间均较术前明显减少未再消融,用胺碘酮治疗可控制(术前胺碘酮治疗无效),5例行第2次消融,术中均发现肺静脉电位有不同程度的恢复,第2次术后3例无再发,2例仍有房颤发作但未再消融,用胺碘酮治疗可控制。④术中及随访期间无任何与操作相关的并发症。结论:非接触三维标测系统指导下的环肺静脉电隔离是治疗房颤有效而安全的方法。
Objective: To investigate the feasibility and clinical efficacy of circumferential pulmonary vein isolation in the treatment of atrial fibrillation (AF) under the guidance of non-contact three-dimensional mapping system. Methods: Twenty-five patients with atrial fibrillation who were ineffective or intolerant of drug therapy were enrolled. A three-dimensional isokinetic potential plot and an electroanatomic graph of the left atrium and pulmonary vein were established by non-contact 3D mapping system. Pulmonary vein and its surrounding tissue electrically isolated. End point of ablation: ① complete all circumferential pulmonary vein ablation line; ② all of the pulmonary vein were isolated electrically; ③ negative results. Results: ①There was no difference in the end point of ablation in all the 25 cases. ② The total operation time and X-ray exposure time were (161.3 ± 23.2) min and (38.0 ± 6.8) min respectively. ③The follow-up ranged from 4 to 12 months, ) Had no episode of atrial fibrillation; 7 cases (28.0%) had recurrence of atrial fibrillation, and 2 of them had no recurrence due to the number of episodes and time significantly decreased compared with that before operation, and amiodarone therapy could be controlled Invalid), 5 cases of the second ablation, intraoperative and pulmonary vascular potential were found to varying degrees of recovery, the second postoperative no recurrence in 3 cases, 2 cases were still atrial fibrillation but no further ablation, with amiodarone Treatment can be controlled. ④ intraoperative and follow-up without any operation-related complications. Conclusion: The pulmonary vein isolation under the guidance of the non-contact 3D mapping system is an effective and safe method for the treatment of atrial fibrillation.