阵发性心房颤动局灶消融后复发病例的大静脉肌袖电隔离治疗

对肺静脉内点消融治疗术后随访 2 2± 1 1 .1个月内的心房颤动 (简称房颤 )复发病例 ,在Lasso标测导管指引下 ,进行再次心内电生理检查及大静脉肌袖电隔离治疗。探讨点消融治疗阵发性房颤后复发的机制 ,并对再次经验性大静脉肌袖电隔离治疗的结果进行分析与评价。 5例患者共接受心内电生理标测和电隔离治疗 6次 (一例行第二次电隔离 ) ,除一例行右下肺静脉靶肌袖的电隔离外 ,其余病例均进行了经验性全部大静脉的电隔离 ,共电隔离心脏大静脉 1 5根 ,其中肺静脉 1 3根、上腔静脉 2根 ,即刻电隔离成功率 1 0 0 %。术后随访 1 1 .8± 8.9个月 ,均无房颤复发。因此 ,对于阵发性房颤导管射频点消融后复发病例进行经验性全部大静脉肌袖电隔离治疗可以满意控制房颤的发作。

Muscle Sleeve Electrical Isolation for Recurrent Cases of Paroxysmal Atrial Fibrillation After Focal Ablation

This study is to evaluate the possible mechanisms of recurrence cases of paroxysmal atrial fibrillation (PAF) after focal ablation and the effects of second myocardial sleeve isolation with radiofrequency ablation technique. Guided by Lasso mapping catheter, isolation ablation procedures were performed in five patients with PAF recurred after focal ablation. Electrical isolation were successfully achieved in 15 veins ( 13 pulmonary veins and 2 superior vena cava ) of 5 cases through 6 procedures. After a mean follow up of 11.8±8.9 months , all cases remained free of PAF without medication. In conclusion, recurrence cases of PAF after focal ablation can be successfully cured with the electrical isolation of pulmonary vein and superior vena. The isolation of at least 3 or 4 veins in one procedure were feasible and preferable for reducing the recurrence of atrial fibrillation. The incidence of pulmonary vein stenosis is relatively low.