应用环状冷冻消融导管行心房颤动电隔离术三例

探讨应用环状冷冻消融导管进行心房颤动(AF)肺静脉电隔离术的临床效果。对1例持续性AF、2例阵发性AF在肺静脉开口处进行冷冻肺静脉电隔离,温度-79℃,每次240～300s(4～5min)。3例共隔离10根肺静脉,消融4.9±2.8(4～10)次。手术时间为205±72(190～265)min。1例持续性AF患者消融后给予300J电复律恢复窦性心律,半月后复发,再次电复律后恢复窦性心律。1例术后一周内仍有阵发性AF。结论应用环状冷冻消融导管进行肺静脉电隔离术安全、有效。     

经皮导管冷冻消融治疗阵发性心房颤动的临床应用

目的:探讨导管冷冻消融术治疗心房颤动的有效性及安全性.方法:对12例阵发性心房颤动患者进行冷冻消融治疗.评价导管冷冻消融术治疗心房颤动的急性成功率、术后并发症以及临床长期有效性.结果:12例阵发性心房颤动患者,共对44根肺静脉进行了冷冻消融,其中29根肺静脉单用环状冷冻导管消融4～6次即能达到肺静脉的完全电隔离,15根肺静脉用环状冷冻导管消融后,需用普通射频消融导管在环形冷冻线上补点消融后才成功隔离肺静脉.随访6～10个月,9例临床症状得到改善,无心房颤动复发,其中3例需服用抗心律失常药维持窦性心律.3例患者心房颤动复发.消融后即刻选择性肺静脉造影和术后6个月核磁共振扫描检查均未发现肺静脉狭窄.结论:经皮导管冷冻消融治疗阵发性心房颤动是安全、有效的,可作为治疗心房颤动的一种有效方法.     

阵发性心房颤动的射频导管消融大静脉电隔离治疗

目的报道阵发性心房颤动(房颤)的射频导管消融电隔离肺静脉和腔静脉的疗效。方法阵发性房颤患者36例,年龄(42.5±13.2)岁。经1次房间隔穿刺放置环状标测电极导管(Lasso导管)和冷盐水灌注消融导管,在Lasso导管的指导下,采用全肺静脉或上腔静脉与靶静脉节段性电隔离相结合的方法对肺静脉和腔静脉行标测和电隔离治疗。窦性心律时最早激动的肺静脉和腔静脉电位处和/或心房起搏时最短的心房和静脉电位间期处为靶点行消融。结果36例阵发性房颤患者均接受一次电隔离治疗,共电隔离大静脉115根,其中左上肺静脉34根,左下肺静脉22根,右上肺静脉30根,右下肺静脉17根,上腔静脉12根,即刻电隔离成功率为95.6%,术中并发症发生率2.78%。随访3~22个月,成功率(无房颤发作或房颤发作明显减少)为75.0%。结论射频导管消融电隔离肺静脉或腔静脉与心房间的电活动连接,可有效预防房颤的复发。治疗的关键是消融靶点的标测和确定。     

导管冷冻消融隔离肺静脉治疗心房颤动

目的探讨导管冷冻消融隔离肺静脉治疗心房颤动的临床疗效？方法回顾性分析15例进行冷冻消融治疗的心房颤动患者的临床资料．着重分析冷冻消融治疗的术前准备、手术方法、手术结果、术后并发症以及随访结果。结果存Lasso标测电极指导下了．用Arctic Circler冷冻消融导管在肺静脉开口附近进i了冷冻消融,隔离肺静脉直至肺静脉电位消失。13例阵发性心房颤动患者中．10例术中维持窦性心律,3例术中有短阵心房颤动发作,但均能自行终止。2例持续性心房颤动患者,1例于冷冻消融进行中终止心房颤动,1例未能在消融治疗中终止．在消融完成后行体外直流电复律1次,成功转为窦性心律,消融成功率为93．3ck（14／15）。共对15例心房颤动患者的54根肺静脉进行了电隔离,其中36根肺静脉单用环状冷冻导管消融4次～6次即能达到肺静脉的完全电隔离．18根肺静脉用环状冷冻导管消融后,需用普通射频消融导管在环形冷冻线上补点消融后才成功隔离肺静脉。术中、术后均无急性肺静脉狭窄等严重并发症发生。随访6个月～10个月,11例临床症状得到改善,无心房颤动复发,其中4例需服用抗心律失常药维持窦性心律,4例心房颤动复发。消融后即刻选择性肺静脉造影和术后6个月核磁共振扫描检查均未发现肺静脉狭窄。结论导管冷冻消融隔离肺静脉是治疗心房颤动的有效方法。     

冷冻直导管行肺静脉节段消融治疗心房颤动的短期效果

目的 探讨使用冷冻直导管节段消融肺静脉治疗心房颤动(房颤)的可行性和短期治疗效果.方法 选择临床确诊阵发性房颤患者11例,采用6 mn冷冻直导管、Lasso导管标测肺静脉电位,节段消融电隔离肺静脉,肺静脉电位消失30 min为消融隔离成功.结果 平均消融术时间(252.55±51.99)min,曝光时间(35.65±9.88)min.共隔离36根肺静脉,平均每根静脉冷冻(7.9±4.1)次.消融即刻成功率100%.平均随访(8.73±4.15)个月,短期成功率81.8%.结论 冷冻直导管节段消融肺静脉治疗房颤的短期效果较好.     

Lasso环形标测电极导管指导阵发性心房颤动肺静脉电隔离

探讨在Lasso环形标测电极导管指导下对阵发性心房颤动 (PAF)患者行肺静脉电隔离术的安全性、有效性。顽固性PAF患者 30例 ,男 19例 ,年龄 5 3± 15 (41～ 70 )岁 ,在肺静脉口用Lasso环形电极导管对肺静脉逐一进行标测 ,于肺静脉最早的心房 肺静脉电位处消融 ,电学隔离肺静脉。消融温度控制在 5 0℃ ,功率 2 5～ 35W。结果 :电学隔离肺静脉 6 9根 ,其中左上肺静脉 2 8根、左下肺静脉 2 0根、右上肺静脉 15根、右下肺静脉 6根 ,电隔离成功6 5根 ;电隔离上腔静脉 6根 ,左房后游离壁异位兴奋灶消融 8个 ,无手术相关并发症。即刻成功率 94 %。随访10 .1± 5 .1(5～ 2 2 )个月 ,成功率 (无心房颤动发作 ) 6 1%。结论 :在Lasso环形标测电极导管指导下对PAF患者行肺静脉电隔离术安全有效 ,是一种很有前途的治疗PAF的消融方法。     

肺静脉冷冻消融电隔离治疗心房颤动的即刻效果

目的探讨冷冻消融行肺静脉电隔离的即刻效果。方法选择临床确诊心房颤动(房颤)患者20例,阵发性房颤16例,持续性房颤4例。采用北极圈冷冻消融导管冷冻隔离肺静脉,Lasso导管标测肺静脉电位,肺静脉电位消失30 min为消融隔离成功。结果平均手术时间(265.88±52.20)min,曝光时间(43.42±17.23)min。实际电隔离57支肺静脉,平均每支肺静脉消融(5.64±2.57)次。2例持续性房颤在消融中终止,2例消融后电转复。7支肺静脉(占总消融肺静脉12.28%)在电位消失后30 min内恢复传导,再次行冷冻消融成功。消融即刻成功率100%。结论经导管冷冻肺静脉电隔离即刻效果较好。为减少复发,隔离后的等待时间是必要的。     

导管射频消融电隔离心脏大静脉治疗阵发性心房颤动的并发症分析

目的总结导管射频消融电隔离肺静脉和(或)上腔静脉(大静脉)治疗阵发性房颤的并发症与合并症. 方法顽固性阵发性房颤患者89例,在环状标测电极指导下行大静脉的导管射频消融电隔离治疗,如能确定触发房颤的靶大静脉,则行靶大静脉的电隔离,如不能确定靶肺静脉,则经验性地行主要肺静脉(双上肺静脉和左下肺静脉)的电隔离,术后重复肺静脉造影.     

射频导管消融进行心房-肺(或上腔)静脉电隔离治疗阵发性心房颤动的并发症分析

目的总结射频导管消融进行心房 肺静脉和 /或上腔静脉 (合称大静脉 )电隔离治疗阵发性心房颤动 (房颤 )的并发症。方法顽固性阵发性房颤患者 89例 ,在环状标测电极导管指导下行大静脉的射频导管消融电隔离治疗 ,分析出现的各种并发症。结果 89例病人共接受电隔离治疗 10 3次 ,隔离大静脉 2 30根 ,其中肺静脉 2 0 7根 ,上腔静脉 2 3根。出现并发症 10例 ,其中严重迷走神经反射导致的一过性三度房室阻滞引起的晕厥发作 2例 ,脑卒中 2例 ,肺静脉狭窄 4例 (狭窄程度 >5 0 % ) ,术后少量心包积血 2例 ,并发症的总发生率为 11%。结论射频导管消融进行心房 肺和 /或上腔静脉电隔离治疗阵发性房颤可出现各种并发症 ,多数并发症可通过采取相应的措施使之减少或避免 ,其中肺静脉狭窄和脑卒中为最棘手的并发症 ,应予以高度重视。     

环状冷冻导管肺静脉电隔离治疗心房颤动的长期疗效观察

目的探讨环状冷冻导管肺静脉电隔离治疗心房颤动(简称房颤)的长期疗效。方法本中心共有17例房颤患者接受并完成了环状冷冻导管肺静脉电隔离术。消融的终点是肺静脉电位消失。随访成功的定义为经3个月洗脱期后无症状性快速性房性心律失常发生。相对有效为患者症状明显缓解,房颤或其它房性心律失常发作频率较术前明显减少,以及服用抗心律失常药物(AADs)后房颤不发作。结果 13例患者完成随访,随访时间5.1±0.5年,其中4例术后未再发作房颤及其他房性心律失常,未服AADs;6例症状改善,其中3例患者服用AADs后房颤未发;3例经AADs治疗后仍有房颤发作,其中1例进行了第2次射频消融治疗。冷冻消融治疗房颤的长期治愈率30.8%,相对有效率46.2%,合计有效率为76.9%。结论环状冷冻导管肺静脉电隔离治疗房颤长期有一定的疗效,但进一步的提高还需更多研究。     

冷冻消融治疗心房扑动和颤动的初步临床应用

报道应用冷冻导管消融His束和消融右房峡部、隔离肺静脉治疗阵发性心房扑动(简称房扑 )合并心房颤动(简称房颤)各 1例。例 1男性, 79岁,因反复心悸伴晕厥入院。心电图示阵发房颤伴快速心室率 190~220次 /分,药物治疗效果差,决定用冷冻导管消融His束。先进行冷冻标测,温度 -30℃,持续时间 <80s,确定靶点后 ( -30℃,冷冻标测 50s,出现房室阻滞,复温后恢复正常传导)开始冷冻消融,温度降至 -80℃,持续时间 4min。成功阻断His束并置入永久起搏器。例 2男性, 65岁,因反复发作典型房扑并房颤入院。术前核磁共振显示左肺静脉严重狭窄,术中先用 8mm冷冻导管消融右房峡部,共消融 5个点后达峡部双向阻滞。再用一种可自动扩张的环形冷冻导管成功隔离右肺静脉。术中患者无疼痛,术后造影无肺静脉狭窄发生。结论:通过冷冻消融的初步临床应用,证明它是一种安全有效的治疗快速心律失常手段。     

Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies

OBJECTIVES: We conducted this study to compare the efficacy and safety of different catheter ablation technologies and of distal versus ostial pulmonary veins (PV) isolation using the circular mapping technique. BACKGROUND: Electrical isolation of the PVs in patients with atrial fibrillation (AF) remains a technical challenge. METHODS: Two hundred eleven patients (163 men; mean age 53 +/- 11 years) with symptomatic AF were included in this study. In the first 21 patients (group 1), distal isolation (> or = 5 mm from the ostium) was achieved targeting veins triggering AF. In the remaining 190 patients (group 2), ostial isolation of all PVs was performed using 4-mm tip (47 patients), 8-mm tip (21 patients), or cooled-tip (122 patients) ablation catheters. RESULTS: Distal isolation was able to eliminate premature atrial contractions (PACs) and AF in six of 21 patients (29%) and 10 of 34 PVs. After a mean follow-up time of 6 +/- 4 months, no patients treated with the 8-mm tip catheter experienced recurrence of AF, whereas 21% (10 of 47 patients) and 15% (18 of 122 patients) of the patients ablated with the 4-mm tip and the cooled-tip ablation catheters experienced recurrence of AF after a mean follow-up of 10 +/- 3 and 4 +/- 2 months, respectively. Significant complications including stroke, tamponade, and severe stenosis occurred in 3.5% (8/211) of patients. CONCLUSIONS: Catheter technologies designed to achieve better lesion size appeared to have a positive impact on procedure time, fluoroscopy time, number of lesions, and overall efficacy. Although distal isolation can be achieved with fewer lesions, ostial isolation is required in the majority of patients to eliminate arrhythmogenic PACs and AF.     

肺静脉和左房内嵴形态与心房颤动射频消融术后早期心律失常的关系

目的探讨肺静脉开口大小和心房内嵴宽度与心房颤动(简称房颤)射频消融术后早期心律失常的关系。方法38例房颤患者应用GE LightSpeed VCT进行CT扫描,采用多平面重组和仿真内窥镜测量四个肺静脉开口内径和心房内嵴的宽度,接受Carto-Merge技术指导的环肺静脉电隔离术,门诊随访3个月。结果术后3个月内,有19例出现房性心律失常,包括16例房性早搏(简称房早),8例短阵房性心动过速(简称房速),7例心房扑动,14例房颤。3个月内出现与未出现各种房性心律失常患者的肺静脉开口面积均无明显差别(P>0.05)。术后早期有短阵房速或房颤的患者左右两侧肺静脉间嵴的宽度都明显大于无短阵房速或房颤的患者(P<0.05)。术后有房早的患者的左心耳与左侧肺静脉间嵴的宽度明显大于无房早者(P<0.05)。结论Carto-Merge技术指导房颤环肺静脉电隔离手术后3个月的各种房性心律失常,与肺静脉开口基本无关,而左心耳与左侧肺静脉间嵴的宽度与术后早期房早有关,左右两侧肺静脉间嵴的宽度与术后早期短阵房速和房颤有关。     

Percutaneous Pulmonary Vein Cryoablation to Treat Atrial Fibrillation

BACKGROUND: Cryothermic tissue injury, unlike hyperthermic tissue injury, preserves tissue architecture and causes less thrombus formation, and thus may prevent venous stenosis and stroke in ablating pulmonary veins (PVs) to treat patients with atrial fibrillation (AF). We investigate the feasibility, efficacy, safety and clinical outcome of using percutaneous cryoablation to treat such patients. METHODS: Thirty-one patients who had drug refractory paroxysmal (20) or persistent (11) AF underwent 37 PV ablative procedures using a 4 mm- or 6 mm-tipped 7F cryoablation catheter (CryoCath Technologies Inc., Quebec, Canada). Segmental isolation at the veno-atrial junction was guided by a distal circumferential mapping catheter. RESULTS: A total of 47 PV were ablated, of which 35/47 (74%) were electrically isolated and the remaining 12/47 had attenuation of PV electrograms, altered activation sequence, and marked slowing of left atrial-PV conduction. There was no change in PV diameter, either immediately following cryoablation (21 +/- 5 versus 22 +/- 6, p = 0.69), or at 18 +/- 9 months follow-up (22 +/- 5 versus 22 +/- 5 mm, p = 0.23). There was no clinical thromboembolic event.The duration of cryoablation for each treated PV and procedural duration was 65 +/- 39 and 290 +/- 101 min, respectively. Following cryoablation, 5/30 (6%) were free from AF and 12/30 (43%) showed improvement from previously ineffective antiarrhythmic drug therapy. 13/30 (43%) patients were unchanged by cryoablation. CONCLUSIONS: Cryothermic ablation shows great promise in reducing the risks of PV stenosis and thrombo-embolism associated with PV isolative procedures. However, cryoablation of these veins with linear catheters is time consuming, and the clinical outcomes are disappointing. Alternative catheter designs are required to overcome these difficulties.     

心房颤动经导管射频消融治疗发生的并发症及处理

目的总结和分析心房颤动(简称房颤)消融过程中发生的并发症及处理经验。方法连续78例房颤患者采用肺静脉开口部节段性消融(SPVI)40例和三维电解剖标测(EnSite3000)指导下环肺静脉线性消融(CPVA)38例,统计其发生并发症的例数和类型。结果发生主要并发症14例,其中急性心包压塞3例,麻痹性肠梗阻1例,肺静脉狭窄5例,严重皮下血肿并出血性休克1例,急性左心衰1例,心包及胸腔积液3例。SPVI组和CPVA组各发生并发症7例。SPVI组主要为肺静脉狭窄(5例),CPVA组主要为心包及胸腔积液(3例)。除肺静脉狭窄外,其余并发症均得到了相应的纠治。结论房颤经导管射频消融并发症的发生与消融方法及操作者的熟练程度有关;及时发现处理,并发症可得到纠正。     

Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome.

AIMS: To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon. METHODS: We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period. RESULTS: During 57 procedures, 185 of 220 targeted PV's were successfully isolated using the cryoballoon (84%) (balloon group, 33 patients). In 33 veins (15%) an additional segmental isolation (hybrid group, 24 patients) was necessary with a standard cryocatheter to achieve isolation. The average procedure times were respectively 211 +/- 108 and 261 +/- 83 minutes (NS), the average fluoroscopy times 52 +/- 36 and 66 +/- 33 minutes (NS). The number of balloon applications did not differ between both groups: respectively a median 9 (4-18) and 10 (5-17) (NS). We observed four phrenic nerve paralysis after ablation of the right superior PV: two resolved immediately after cessation of the cryoenergy, one recovered after 3 months, one persisted up to 6 months. A daily transtelephonic rhythm recording showed a significant drop in mean AF burden from 24% to 10%, 8% and 5% during the three consecutive months of follow-up (p < 0.01 versus baseline). No differences were observed between the treatment groups. 34 patients (60%) were completely free from AF after a single procedure. CONCLUSIONS: Balloon cryoablation of the pulmonary veins with additional segmental isolation if necessary, is a good approach for patients presenting with paroxysmal AF, showing a significant reduction in AF burden after a single procedure. The major complication seems to be phrenic nerve paralysis after ablation of the right superior PV, but this is potentially reversible over several months.     

Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis

OBJECTIVES: We sought to evaluate the efficacy and safety of pulmonary vein (PV) isolation using transvenous cryoablation for the treatment of atrial fibrillation (AF). BACKGROUND: Although electrical isolation of PVs with radiofrequency energy for the treatment of AF is feasible, it is associated with a significant risk of PV stenosis. Cryoablation is a new alternative therapy allowing ablation of tissue while preserving its underlying architecture. METHODS: In 52 patients with paroxysmal (n = 45) or persistent (n = 7) AF, PV isolation using the CryoCor cryoablation system (CyroCor Inc., San Diego, California) with a 10F deflectable transvenous catheter was performed as guided by ostial PV potentials. Cryoablation was applied twice at each targeted site (2.5 to 5 min/application). Computed tomography (CT) of the thorax was performed at baseline and at 3 and 12 months to evaluate for PV stenosis. RESULTS: All targeted PVs were completely isolated in 49 (94%) of 52 of patients. Of 152 PVs targeted, 147 (97%) were successfully isolated (mean 3.0 PVs isolated per patient). After a mean period of 12.4 +/- 5.5 months of follow-up, 37 (71%) of 52 patients had no recurrence of AF or were clinically improved, including 29 patients (56%) who had no recurrence of AF with (n = 11) or without the use of anti-arrhythmic drugs. At 3 and 12 months, the CT scan showed no evidence of PV stenosis associated with cryoablation in any patients. CONCLUSIONS: Transvenous catheter cryoablation is an effective method to create PV electrical isolation for the treatment of AF. A clinically satisfactory result can be achieved in 71% of patients with AF, without the risk of PV stenosis.     

Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation,atrial flutter,Wolff-Parkinson-White syndrome,atrioventricular nodal reentry tachycardia)

INTRODUCTION: Radiofrequency (RF) catheter ablation currently is used for treatment of cardiac arrhythmias. Although the success rate is high for almost all supraventricular tachycardias (SVT), this technique has some drawbacks, especially when pulmonary veins (PV) are targeted for treatment of atrial fibrillation (AF). Additionally, new techniques for isolation of the PVs have the drawback that they can be used only for PV isolation and not for routine treatment of other SVTs. The aim of this study was to report on the safety and efficacy of a new cryoablation system for treatment of all SVTs. METHODS AND RESULTS: Forty-nine patients with SVT (38 men; age 48 years, range 23-76) were enrolled in the study. Five patients were withdrawn from the study before they underwent cryoablation. The remaining 44 patients were treated with cryoablation (22 AF, 15 atrial flutter, 3 accessory pathway, 2 AV nodal reentrant tachycardia, 1 AV junction ablation for permanent AF, 1 atrial tachycardia). Cryoablation was performed with the CryoCor cryoablation system, which uses a precooling system and N2O as a refrigerant. The number of freezes applied varied according to the index arrhythmia treated. Successful isolation of PVs was performed in 20 of (96%) 21 AF patients and 53 of 55 veins. The overall acute success was 98% (43/44). Fifty-three PVs were isolated (2.5/patient). The success rate was 100% (23/23) for right-sided procedures. The average and nadir temperatures reached in right-sided and left-sided procedures were -77 degrees C and -80 degrees C and -75 degrees C and -78 degrees C, respectively. No acute PV stenosis was seen. CONCLUSION: This novel cryoablation system appears to be safe and can successfully treat different types of SVTs, including AF. Isolation of PVs is possible without producing stenosis. Despite the high blood flow in the right atrial isthmus and PVs, bidirectional conduction block can be achieved.