EnSite NavX指导下无肺静脉造影的阵发性心房颤动导管消融术

目的探讨不作肺静脉造影行阵发性心房颤动(房颤)环肺静脉电隔离术的有效性和可行性。方法 34例阵发性房颤患者分为无肺静脉造影组(n=18)和肺静脉造影组(n=16),无肺静脉造影组不作肺静脉造影,余步骤与肺静脉造影组相同,两组均在EnSiteNavX三维标测系统指导下重建左心房及肺静脉,再分别行左、右环肺静脉电隔离术,消融终点为肺静脉与心房完全电隔离。结果无肺静脉造影组消融术时间(92.78±19.46)minvs.(106.44±20.18)min,P0.05]及X-线曝光时间(11.47±4.32)minvs.(16.06±8.72)min,P0.05]少于肺静脉造影组,差异有统计学意义。两组左心房三维重建时间(6.22±2.65)minvs.(6.31±3.00)min,P0.05]、左、右侧环肺静脉消融时间(21.61±7.66)minvs.(20.50±8.09)min,P0.05;(17.33±10.22)minvs.(17.48±7.86)min,P0.05]及即刻消融成功率100%(18/18)vs.100%(16/16),P0.05]比较,差异无统计学意义。结论不作肺静脉造影,仅在三维标测系统指导下行房颤消融治疗,可达到相同消融效果,可节省消融术及X-线曝光时间,减少手术步骤、耗材和费用。

EnSite NavX guided catheter ablation for paroxysmal atrial fibrillation without pulmonary venography

Objectives To study the optimal catheter ablation feasibility without pulmonary venography for paroxysmal atrial fibrillation（AF）.Methods Thirty-four consecutive cases with paroxysmal AF undergoing catheter ablation therapy were divided into non-pulmonary venography group （18 patients） and pulmonary venography group （16 patients） from Oct. to Nov.in 2009. The procedures were guided by EnSite NavX mapping system and circle catheter, all patients were performed circumferential pulmonary vein isolation （CPVI）. The ablation endpoint was set to complete isolation of pulmonary vein potential from left atrium. Results Total procedure time （92.78±19.46）min vs.（106.44±20.18）min, P〈0.05 ] and X-ray exposure time （ 11.47±4.32）min vs. （ 16.06±8.72）min, P〈0.05 ] significantly decreased in non- pulmonary venography group than in pulmonary venography group. There was no significant difference of left atrium modeling time （6.22±2.65）min vs. （6.31±3.00）min, P〉0.05], CPVI time of left and right pulmonary vein （21.61±7.66）min vs. （20.50±8.09） min, P〉0.05 ; （ 17.33± 10.22） min vs. （ 17.48±7.86 ） min,P〉0.05 ], and immediate ablation achievement ratio 100%（18/18） vs. 100%（16/16）,P〉0.05]between the 2 groups. Conclusions Catheter ablation therapy without pulmonary venography for paroxysmal atrial fibrillation can decrease operation time, X-ray exposure time, ablation step and medical expenses. It is feasible and effective.