心房颤动肺静脉电隔离后肺静脉自发电位分析

目的探讨心房颤动(简称房颤)患者肺静脉电隔离后发生肺静脉自发电位的相关因素。方法153例患者,其中阵发性房颤114例,持续性或永久性房颤39例,术前行肺静脉CT血管造影并测量肺静脉最大直径,行环肺静脉消融肺静脉电隔离术,并进行肺静脉自发电位标测及其相关因素评价。结果术中,69例(45.1%)共125根肺静脉(20.1%,125/621)标测到自发电位。左上肺静脉最大径(LSPV,18.5±4.0mm)及右上肺静脉最大径(RSPV,18.7±4.2mm)均大于左下肺静脉(LIPV,15.2±3.0mm)及右下肺静脉(RIPV,16.3±3.8mm)(P均<0.001),右侧肺静脉大于左侧肺静脉(17.5±4.2mmvs16.8±3.9mm,P=0.012);有自发电位的RSPV最大径大于无自发电位的RSPV(20.0±3.8mmvs18.3±4.3mm,P=0.027)。右侧肺静脉自发电位发生率高于左侧肺静脉(25.5%vs15.1%,P=0.002),RSPV和RIPV自发电位发生率均高于LIPV(27.2%,23.8%vs11.4%,P<0.001与P=0.005)。RSPV自发电位发生率与RSPV最大径正相关(β=0.097,P<0.05)。结论肺静脉最大径越大则自发电位的发生率越高,而RSPV有无自发电位与RSPV最大径明显相关。

The correlative factors of spontaneous pulmonary vein potentials in patients with atrial fibrillation who undergo pulmonary vein isolation

Objective The correlative factors of spontaneous pulmonary vein (PV) potentials in patients with atrial fibrillation (AF) who underwent circumferential PV ablation and PV isolation were explored. Methods A total of 153 consecutive patients with AF, including paroxysmal AF in 114 patients (74.5%) and persistent or permanent AF in 39, were enrolled in this study. The mean duration of AF was 6.6±6.1 years. The maximum diameter of the basilar part of PVs was measured using CT angiography of PVs and 3D image software. The spontaneous PV potentials (SPVP) were evaluated after successful PV isolation. Results The SPVP were identified in 125 PVs (20.1%) of 69 patients (45.1%).The maximum diameter of left superior PVs (LSPV, 18.5±4.0 mm) and right superior PVs (RSPV,18.7±4.2 mm) were both significantly larger than that of left inferior PVs (LIPV,15.2±3.0 mm) and right inferior PVs (RIPV,16.3±3.8 mm)(all P< 0.001). The maximum diameter of right PVs (the right superior and the right inferior PVs,17.5±4.2 mm) was significantly larger than that of left PVs (the left superior and the left inferior PVs,16.8±3.9 mm) (P= 0.012). The maximum diameter of RSPV with spontaneous potential was significantly larger than that of RSPV without spontaneous potential (20.0±3.8 mm vs 18.3±4.3 mm,P= 0.027). The incidence of SPVP in right PVs was significantly higher than that in left PVs (25.5% vs 11.4%, P< 0.05). The incidence of SPVP in RSPV(27.2%) and RIPV(23.8%) were significantly higher that in LIPV(11.4%, P< 0.001 and P= 0.005, respectively).The incidence of SPVP in RSPV was positively correlated to its maximum diameter (β=0.097, P< 0.05). Conclusion The incidence of SPVP is related to the basilar diameter of PVs.