摘要
目的分析肺静脉前庭重构与环肺静脉前庭电隔离术(CPVI)后肺静脉-左房电传导恢复之间的关系。方法入选2007年1月至2009年9月因房颤行导管射频消融术后复发,再次消融患者359例(阵发性房颤180例,持续性房颤179例)。LASSO环状电极标测肺静脉-左房电传导恢复情况,在Carto系统引导下行补点消融。利用CARTO系统自带软件测量左右肺静脉前庭面积。结果 359例患者均顺利完成导管射频消融。阵发性房颤患者中有144例(80%)电传导恢复,其中单支肺静脉电传导恢复占45例(31.25%),2支占58例(40.28%),3支占24例(16.67%),4支恢复占17例(11.81%)。持续性房颤患者中有155例(86.59%)电传导恢复,其中单支肺静脉电传导恢复占24例(15.48%),2支占72例(46.45%),3支占17例(10.97%),4支占42例(27.1%)。阵发性房颤左肺静脉前庭面积(6.15±0.65)cm2,右肺静脉前庭面积(7.95±2.24)cm2。持续性房颤左肺静脉前庭面积(10.48±1.00)cm2,右肺静脉前庭面积(11.4±2.16)cm2。统计学分析提示阵发性房颤CPVI术后单支肺静脉电传导恢复比例高于持续性房颤(P=0.001),而持续性房颤4支肺静脉电传导恢复比例高于阵发性房颤(P=0.001)。阵发性房颤左、右肺静脉前庭面积均小于持续性房颤(P<0.001,P=0.022)。结论持续性房颤肺静脉前庭重构程度高于阵发性房颤,因此持续性房颤电隔离术后肺静脉-左房电传导恢复比例高于阵发性房颤。
Objective To explore the relationship between pulmonary vein antrum remodeling and recovered pulmonary vein conduction to left atrium after circumferential electrical isolation of pulmonary vein ostia.Methods A consecutive cohort of 359 cases undergoing re-procedures of catheter radiofrequency ablation because of atrial fibrillation recurrence from Jan 2007 to Sep 2009,including 180 patients with paroxysmal atrial fibrillation and 179 cases with persistent atrial fibrillation,were recruited.A decapolar circular mapping catheter（Lasso）was positioned in pulmonary vein to map recovered pulmonary vein conduction to left atrium.Under the guidance of electroanatomical mapping system（CARTO）,the gaps were located and ablated.The left and right pulmonary vein antrun areas were measured by the software of the CARTO system.Results Catheter radiofrequency ablation was performed successfully on all the subjects.Recovered pulmonary vein conduction was demonstrated in 144 of 180（80%）cases with paroxysmal atrial fibrillation,including 45 cases（31.25%）with single pulmonary vein re-conduction,58 cases（40.28%）with two,24 cases（16.67%）with three and 17 cases（11.81%）with four.Pulmonary vein re-conduction was observed in 155 of 179（86.59%）individuals with persistent atrial fibrillation,including single pulmonary vein re-conduction in 24 cases（15.48%）,two in 72 cases（46.45%）,three in 17 cases（10.97%）and four in 42 cases（27.1%）.The area of left and right pulmonary vein antrum in patients with paroxysmal atrial fibrillation was 6.15±0.65 cm2 and 7.95±2.24 cm2,respectively.Whereas the area of left and right pulmonary vein antrum in patients with persistent atrial fibrillation was 10.48±1.0 cm2 and 11.4±2.16 cm2,respectively.Compared with that in persistent atrial fibrillation,the re-conduction rate of single pulmonary vein was higher（P=0.001）,but the re-conduction rate of four pulmonary veins was lower（P=0.001）in paroxysmal atrial fibrillation.The areas of both left and right pulmonary vein vestibules in paroxysmal atrial fibrillation were smaller than those in persistent atrial fibrillation（P0.001 and P=0.022,respectively）.Conclusion The pulmonary vein antrum in persistent atrial fibrillation is remodeled to greater degree than that in paroxysmal atrial fibrillation,hence the proportion of recovered pulmonary vein conduction to left atrium after circumferential electrical isolation of pulmonary vein ostia in persistent atrial fibrillation is more than that in paroxysmal atrial fibrillation.
出处
《中国介入心脏病学杂志》
2010年第5期266-270,共5页
Chinese Journal of Interventional Cardiology
关键词
心房颤动
肺静脉
导管消融术
Atrial fibrillation
Pulmonary veins
Catheter ablation
