非接触心内膜激动标测系统引导下的左房消融治疗阵发性心房颤动的初步研究

为探讨非肺静脉起源的阵发性心房颤动 (简称房颤 )用非接触心内膜激动标测系统 (EnSite30 0 0 )标测房颤的起始激动部位、折返途径与传导以及射频消融术治疗的方法、效果及其安全性。对 6例左房起源的房颤 ,用改良Ross法穿刺房间隔后置入EnSite30 0 0标测球囊导管于左房 ,将大头导管分别送至左上、下肺静脉 ,右上、下肺静脉 ,二尖瓣口及在左房前后、左右各壁移动 ,描记左房三维几何图形。记录诱发房颤的房性早搏 (简称房早 )起源点、房颤起始的传导方向、折返部位。设计消融点与消融线 ,用 5 0～ 5 5℃温控消融导管放电 ,每点 6 0s。参考消融终点 :①房早等房性心律失常消失 ,必要时静脉滴注异丙肾上腺素重复检查 ;②设计的线状消融部位传导中断 ;③先前的电生理方法不能诱发房颤和其他房性心律失常。结果 :经EnSite30 0 0标测 ,6例房早均起源于左房后壁 ,其中单点起源 2例、多点起源 4例 ;折返限于左房壁 2例、与左上肺静脉有关 3例、与右上肺静脉有关 2例、合并典型心房扑动 1例。EnSite30 0 0引导下的左房消融术 3例成功、3例有效 ,无并发症发生。随访 1个月 ,2 4h动态心电图检查术后房早明显减少 (5 6 .8±7.5 8个vs 15 2 6 2 .4± 8914 .5个 ,P <0 .0 0 1)。结论 :用EnSite30 0 0能准确标测左房非?

The Initial Study of Radiofrequency Catheter Ablation in Patient with Paroxysmal Atrial Fibrillation Originating From Left Atrium Under the Guidance of Non-Contact Mapping System(EnSite 3000).

The purpose of this study is to approach the method,effectiveness and safety of radiofrequency catheter ablation(RFCA) and origin of paroxysmal atrial fibrillation(PAF) which does not originate from pulmonary vein,the circuit of reentry and conduction in patient with PAF,under the guidance of non contact mapping system.We passed through the septa by the way of reform Ross′s and put the mapping balloon of non contact mapping system into the left atrium for the 6 patients with PAF originating from left atrium.We moved the ablation catheter from left superior pulmonary vein to left inferior pulmonary vein,right superior pulmonary vein,right inferior pulmonary vein,mitrial orifice and all the wall of the left atrium in turn to draw the simulate left atrial three dimensional space,recorded the origin of atrial premature beat by which the PAF was induced,the direction of conduction and the circuit of reentry.We designed the lesion of ablation,performing ablation between 50～55 ℃ with the temperature control catheter and lasting about 60 seconds at each point.The reference endpoints of ablation were as following:①The atrial arrhythmias such as atrial premature beats disappeared.②The circuit of reentry was broken down.③The PAF could not be induced by normal electrophysiological examination.Result:We found atrial premature beat originating from post wall of left atrium in all 6 cases by EnSite 3000,single origin in 2 cases,multiple in 4 cases.The circuit of reentry located in the post wall of left atrium in 2 cases,related to left superior pulmonary vein in 3 cases,related to right superior pulmonary vein in 2 cases,and accompanied with typical atrial flutter in 1 case.PAF was successfully performed in all 6 cases under the guidance of EnSite 3000.There were no complications during and after the procedure.During 1 month follow up,the atrial premature beats were reduced from 15262.4±8914.5 to 56.8±75.8( P <0.001) in DCG.Conclusion:This study suggested that it is accurately that non contact mapping system in mapping the origin,the direction of conduction and the circuit of reentry of PAF which does not originate from pulmonary vein and can guide the ablation of PAF effectively.