无左心房和肺静脉三维重建的阵发性心房颤动导管消融术

目的探讨无左心房和肺静脉三维重建与有左心房三维重建的Carto系统引导下阵发性心房颤动（房颤）导管消融术的差异。方法入选2008年1月至12月在本中心由同一位熟练术者行Carto系统引导下导管消融术的阵发性房颤患者31例，其中17例接受无左心房和肺静脉三维重建的消融术（非重建组），14例接受有左心房三维重建的消融术（重建组）。具体消融方法为以环肺静脉电隔离为基础，按照个体情况选择是否行三尖瓣峡部画线消融。消融终点均为肺静脉电位与心房完全隔离，电生理检查不可诱发持续的房颤、心房扑动和房性心动过速。对比上述两组患者消融术中各步骤的耗时情况，并进行随访。结果重建组男女比例为10：4，非重建组为11：6，P〉0．05；重建组年龄（54．64±15．58）岁，非重建组（59．41±10．59）岁，P〉0．05；重建组房颤病程（5．05±10．4）年，非重建组为（7．34±7．74）年，P〉0．05。重建组左心房内径（35．29±4．73）mm，非重建组是（36．47±6．15）mm，P〉0．05。重建组消融术时间（107．23±28．92）min，非重建组是（93．47±26．09）min，P〉0．05；重建组X线曝光时间（21．09±6．49）min，非重建组是（14．16±5．35）min，P〈0．05；重建组环右肺静脉消融时间（27．29±18．53）min，非重建组是（18．00±4．51）min，P〈0．05；重建组环左肺静脉消融时间（28．14±9．26）min，非重建组是（23．94±7．10）min，P〈0．05。消融术后随访2～13个月，重建组85．7％无明显房颤发作，非重建组是82．4％（P〉0．05）。结论与有左心房三维重建的Carto系统引导下的阵发性房颤导管消融术相比，无左心房和肺静脉三维重建可以缩短消融术和x线曝光时间，可以达到相同的消融效果。

CartoXP guided catheter ablation for paroxysmal atrial fibrillation without three-dimensional modeling of left atrium and pulmonary veinsWEI Wei, YANG Ping-zhen, ZHAN Xian-zhang, XUE Yu-mei, FANG

Objective To investigate the differences between modeling and non-modeling left atrium in Carto XP system guided catheter ablation for paroxysmal atrial fibrillation. Methods Thirty-one cases of par-oxysmal atrial fibrillation treated by the same electrophysiologist with guidance of Carto XP during Jan to Dec in 2008 were enrolled. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients (non-modeling group) and with left atrium modeling in 14 patients (modeling group). The detailed ablation method was based on circumferential pulmonary veins isolation (CPVI). And linear ablation of tricus-pid valvular isthmus was selectively proceeded individually. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium and no continuous fast atrial arrhythmia including atrial fibrillation, atrial flutter and atrial tachycardia could be induced. Comparisons for each step during procedure and the fol-low-up outcomes had been done. Results The male: female ratio of the 2 groups were 10:4 and 11 : 6 (P >0.05). The average age were (54.64 ± 15.58) and (59.41 ± 10.59) (P >0.05) ,the diseased courses were (5.05 ±10.4) years and (7.34±7.74)years(P >0.05),the left atrial sizes were (35.29±4.73) mm and (36.47 ±6.15)mm (P > 0.05), the total procedure time was (107.23±28.92) rain and (93.47 ±26.09) win (P>0.05). The X-ray exposure time was (21.09 ±6.49)min (modeling group) and (14.16±5.35)min (non-modeling group,P < 0.05). The CPVI time of fight pulmonary veins was (27.29±18.53) rain (model-ing group) and 18.00 ±4.51 min (non-modeling group, P < 0.05). The CPVI time of left pulmonary veins was (28.14 ±9.26) rain (modeling group) and (23.94±7.10) rain (non-modeling group, P < 0.05). The successful rates was 85.7% (modeling group) and 82.4% (non-modeling group, P > 0.05) over follow-up for 2 to 13 months. Conclusion Carto system guided catheter ablation of paroxysmal atrial fibrillation without modeling of left atrium and pulmonary veins could take less time in X-ray exposure and ablation steps, compa-ring with left atrium modeling one.