持续性心房颤动导管消融术中不同终点与临床疗效关系

目的 评价持续性心房颤动(房颤)导管消融术中不同终点与临床成功率的关系.方法 2006年9月至2007年3月入选持续性房颤患者124例,男性76例,女性48例,平均年龄(62.4±11.5)岁.平均左心房内径(44.6±6.5)mm,平均房颤病程(2.34±3.5)年.消融术式采用Carto系统引导环肺静脉前庭隔离(CPVI)和心房复杂碎裂电位(CFAEs)消融,单Lasso导管标测肺静脉电位.按照消终点分组:CPVI终止房颤组、CPVI转化为房性心动过速(房速)组、CPVI+CFAEs终止房颤组、CPVI+CFAEs转化为房速组以及CPVI+CFAEs后仍为房颤组.消融结束未恢复窦性心律者均行直流电转复.消融术后随访心电图和24 h动态心电图.结果 所有患者顺利完成消融术.平均消融术时间(201±34)min,平均x线透视时间(23±12)min.CPVI恢复窦性心律4例,CPVI使房颤转变为房速5例(2例消融成功,3例消融未终止).共115例进行CFAEs标测和消融:20例转复为窦性心律;24例转化为房速(其中13例消融成功,11例消融未终止).共71例消融结束仍为房颤,均经直流电复律成功转复.术后平均随访(4.5±2.1)个月,共有34例患者接受再次消融.随访(9.5±2.7)个月,CPVI终止房颤组4例无复发,CPVI转化为房速组4例无复发,1例复发房速;CPVI+CFAEs终止房颤组17例无复发,2例复发房速,1例复发房颤;CPVI+CFAE8转化为房速组17例无复发,5例复发房速,2例复发房颤.CPVI+CFAEs仍为房颤组术后36例成功,25例复发房颤,10例复发房速,P=0.01.结论 持续性房颤消融术中不同终点影响临床成功率.消融术中恢复窦性心律或转变为房速成功率高,消融术中未恢复窦性心律或转变为房速消融成功率较低.

The relationship between different endpoints of catheter ablation for persistent atrial fibrillation and clinical effectiveness

Objective To evaluate the relationship between different endpoints of catheter ablation for persistent atrial fibrillation and clinical effectiveness. Methods From Sept. 2006 to Mar. 2007,124 cases [76 males, mean age (62.4±11.5) yrs] with persistent atrial fibrillation (AF) were included for catheter ablation.The mean left atrium diameter was (44.6±6.5) mm and mean history of AF was (2.3±3.5) yrs. Circumfer-ential pulmonary vein isolation(CPVI) and CFAEs ablation were performed sequentially in all cases. According to various acute results cases were divided into five groups:AF terminated by CPVI,AF converted to atrial tach-yeardia(AT)by CPVI,AF terminated by CPVI+CFAEs ablation,AF converted to AT by CPVI + CFAEs abla-tion,and AF continued after CPVI + CFAEs ablation. ECG and Holler were utilized for effectiveness evaluation.Results All cases underwent the procedure successfully, with the mean procedural time of(201±34) rain and mean fluoroscopic time of(23±12)min. AF terminated in 4 cases by CPVI,and converted to AT in 5 cases(AT ablation succeeded in 2 and failed in 3). Of 115 cases with CFAEs ablation performed AF terminated in 20 cases and converted to AT in 24 cases( AT ablation succeeded in 13 cases and failed in 11 cases),AF contin-ued after combined ablation in 71 cases and was cardioverted by DC shock. Thirty-four cases underwent second ablation due to AT recurrence. During mean follow-up of(9.5±2.7)months,4 eases with AF termination by CPVI were atrial tachyarrhythmias(ATa) free;4 cases with AF conversion to AT by CPVI were ATa free(1 case with AT recurrence);17 cases with AF termination by CPVI + CFAEs ablation were ATa free (the remaining2 cases with AT and 1 case with AF);17 cases with AF conversion to AT by CPVI + CFAEs were ATa free (the remaining 5 cases with AT and 2 cases with AF). Thirty-six cases with AF maintenance after CPVI + CFAEs ablation were ATa free(the remaining 25 cases with AF and 10 cases with AT),P =0.01. Conclusions Differ-ent endpoints of catheter ablation for persistent atrial fibrillation have impact on clinical effectiveness. Cases with AF termination or conversion to AT have significantly higher success rate than those without AF termination or conversion to AT.