摘要
目的:分析心房颤动(房颤)上腔静脉节段性电隔离的具体手术方法,并评估其安全性。方法:入选2017年11月至2018年9月期间我院阵发性房颤患者50例,患者常规进行肺静脉隔离后,继续行上腔静脉隔离。消融前进行上腔静脉造影,显示上腔静脉与右心房解剖关系,并在CARTO系统运用PentaRay电极导管进行上腔静脉及右心房三维解剖重建,将消融大头送至上腔静脉与右心房交界上方约1~2 cm处,沿上腔静脉壁环行起搏消融大头远端,并确定膈神经反应部位,并在上腔静脉及右心房三维解剖模型进行标记,在相同水平部位行上腔静脉线性消融,消融中避开模型中所标记的侧膈神经反应部位。结果:入选患者均进行肺静脉电隔离+上腔静脉电隔离,在上腔静脉消融中49例患者均在未消融到引起膈肌刺激部位时已成功隔离上墙静脉电位,仅一例患者需消融术中标记到的膈肌刺激部位而放弃上腔静脉电隔离,术中及围术期无一例出现膈神经麻痹及窦房结损伤。术后随访12个月,未发现患者出现膈神经损伤及窦房结损伤相关症状。结论:根据本中心方法行上腔静脉隔离方法安全有效。
Objectives:To report the safety and efficacy of segmental isolation of superior vena cava(SVC)during atrial fibrillation(AF)ablation.Methods:50 consecutive patients with paroxysmal AF,who underwent AF ablation from November 2017 to September 2018,were enrolled.After routine pulmonary vein isolation(PVI),segmental superior vena cava isolation was performed.Before ablation,superior vena cava angiography was performed to show the anatomical relationship between superior vena cava and right atrium,and three-dimensional anatomical reconstruction of superior vena cava(SVC)and right atrium(RA)was performed using PentaRay electrode catheter of the CARTO system.The ablation catheter was advanced to 1-2 cm above the junction between SVC and RA.Then,pacing ablation was performed along the wall of the SVC and the site of phrenic nerve reaction was determined and marked.The segmental linear ablation of the SVC could then be performed safely without injuring the phrenic nerves.Results:All patients received pulmonary vein isolation as well as SVC isolation.The superior vena cava potential isolation was achieved in 49 patients in the absence of diaphragmatic paralysis or sinoatrial node dysfunction.Complete SVC isolation was not achieved in one patient due to phrenic stimulation.No phrenic nerve injury and sinoatrial node injury related symptoms were noticed during the one-year follow-up.Conclusions:According to our experience,segmental superior vena cava isolation during atrial fibrillation ablation can be achieved safely with high success rate.
作者
李希
张劲林
唐成
邓成钢
程光辉
黄尾平
郭再雄
LI Xi;ZHANG Jinlin;TANG Cheng;DENG Chenggang;CHENG Guanghui;HUANG Weiping;GUO Zaixiong(Depardment of Cardiology,Wuhan Asia Heart Hospital,Wuhan(435000),Hubei,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第1期39-42,共4页
Chinese Circulation Journal
基金
武汉市科学技术局科研项目(2015060101010062)。
关键词
心房颤动
导管消融
上腔静脉电隔离
膈神经麻痹
atrial fibrillation
catheter ablation
superior vena cava isolation
phrenic nerve paralysis
