环肺静脉电隔离术后心房-肺静脉电位恢复情况的随访

目的明确环肺静脉电隔离术的长期效果以及心房-肺静脉电位传导恢复的具体部位,以提高手术成功率,预防复发。方法 232例再次行心房颤动(简称房颤)射频消融的患者,采用Lasso环状电极标测,明确其心房-肺静脉电位恢复部位,并在CARTOTM系统指导下予以消融。结果 232例第2次手术病例术中标测示44例(19.0%)无心房-肺静脉电位传导恢复,且术中心房-肺静脉电位传导恢复的部位多存在于左肺静脉前上部65例(28%)、前下部49例(21.1%)、右肺静脉后上部59例(25.4%)及后下部61例(26.3%)。28例行第3次手术,术中标测示无心房-肺静脉电位传导恢复的有16例(57.1%)。5例第4次手术术中标测仅有1例左下肺静脉电位恢复。结论环肺静脉隔离术后,随着随访时间延长肺静脉电位传导有恢复的趋势,并且心房-肺静脉电位传导存在易恢复区,多集中于左肺静脉前上部、前下部、右肺静脉后上部及后下部。部分心房-肺静脉电位传导经多次手术可达完全隔离。

Distribution of recovery of electrical connections between the pulmonary veins and the left atrium after circumferential pulmonary vein isolation

Objective To investigate the prevalence of pulmonary vein （PV）conduction recovery during the following time after circumferential pulmonary vein isolation（CPVI） and explore the distribution of PV re-connections. Methods Two hundred and thirty-two cases with paroxysmal or persistent AF were enrolled for re-ablation. CARTOTM-guided CPVI was performed in all cases with one circular catheter for verification of PVs isolation. Results 232 cases underwent 2 procedures, from which no PV re-connections was identified in 44 （19.0%）cases, meanwhile, PV re-connections were most commonly situated at the left pulmonary antero-superior segment 65 （28%）, left pulmonary antero-inferior segment 49 （21. 1% ） ,right pulmonary postero-superior segment 59 （25.4%）, right pulmonary postero-inferior segment 61 （26.3%）. 28 cases underwent 3 procedures and no PV re-connections was observed in 16（57.1% ）cases. 5 cases underwent d procedures and only one PV re-connections was observed in left pulmonary antero-inferior segment. Conclusion Electrical connections between the pulmonary veins and the left atrium have recovery tendency with the following time going after CPVI. PV re-connections are most commonly situated at the left pulmonary antero-superior , antero-inferior segment, right pulmonary the postero-superior , postero-inferior segment. Part PVs could be isolated completely after several procedures. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2010 ,24 （4） ： 329 - 332 ]