射频消融治疗心房颤动和心房扑动策略探讨

被引：2

作者：

郭方明 ^{[1
,2
]}

李广平 ^{[1
]}

王效浣 ^{[1
]}

崔松 ^{[3
]}

陈欣 ^{[1
]}

许纲 ^{[1
]}

机构：

[1] 天津医科大学第二医院心内科

[2] 烟台市烟台山医院

[3] 首都医科大学北京安贞医院心内科

来源：

中华临床医师杂志(电子版) | 2009年 / 3卷 / 09期

关键词：

心房颤动; 心房扑动; 导管消融术; 复发; 肺静脉峡部; 碎裂电位;

D O I：

暂无

中图分类号：

R541.7 [心律失常];

学科分类号：

1002 ; 100201 ;

摘要：

目的评价射频消融使肺静脉电解剖隔离和消除左房碎裂电位治疗心房颤动(简称房颤)的效果,进一步探讨与心房扑动(简称房扑)的关系。方法63例房颤患者分为两组,其中阵发性房颤32例,持续性房颤31例。在Ensite NavX三维标测系统下,建立左心房-肺静脉电解剖模型,分别对左、右肺静脉前庭大环状消融达完全左心房-肺静脉电解剖隔离,若房颤未终止或被诱发,再标测左心房内碎裂电位,消融碎裂电位;对22例合并典型房扑者行三尖瓣峡部消融。随访9个月观察影响手术复发的因素。结果所有患者均达左心房-肺静脉电解剖隔离。32例阵发性房颤患者中23例(71.9%)和31例持续性房颤患者8例(25.8%)经单纯肺静脉电隔离后房颤终止,不被诱发,两者相比有统计学意义(P<0.01);7例(21.8%)阵发性房颤和19例(61.3%)持续性房颤患者经联合消融左心房碎裂电位转复窦律,2例阵发性房颤和4例持续性房颤患者住院期间转复,术中总房颤即刻终止率两组相比较无统计学意义(P>0.05)。阵发性房颤和持续性房颤患者消融成功率分别为84.4%和80.6%(P=0.697),多元Logistic回归分析显示合并典型房扑是房颤术后复发的一个危险因素(P=0.007)。结论肺静脉电解剖隔离结合消除左心房碎裂电位是治疗房颤的一种有效策略,房颤和房扑的启动与维持可能存在一些共同机制。

引用

页码：1514 / 1519

页数：6

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