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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。
Objective To clarify the long-term effect of circumferential pulmonary vein isolation and the specific site of atrial-pulmonary venous potential conduction recovery in order to improve the success rate of surgery and prevent recurrence. Methods A total of 232 patients who underwent atrial fibrillation radiofrequency ablation were examined by Lasso ring electrode to confirm the location of atrial-pulmonary venous potential recovery and to be ablated under the guidance of CARTOTM system. Results Of the 232 cases of the second operation, 44 cases (19.0%) had no atrial-pulmonary venous potential conduction recovery and there were 65 cases (28%) of the anterior superior left pulmonary veins in operation. 49 cases (21.1%) in the anterior lower part, 59 cases (25.4%) in the posterior upper right pulmonary vein and 61 cases (26.3%) in the posterior lower part. Twenty-eight cases underwent the third operation, and 16 cases (57.1%) recovered without evidence of atrial-pulmonary venous potential conduction. In 5 cases of the 4th surgery, there was only 1 case left lower pulmonary vein potential recovery. CONCLUSIONS: Pulmonary venous potential conduction tends to recover with prolonged follow-up, and the atrial-pulmonary venous potential conduction exists in the easy-to-recover zone, which is mostly concentrated in the anterior superior and anterior lower anterior and posterior inferior pulmonary veins. Part of the atrium - pulmonary venous potential conduction through multiple surgeries up to complete isolation.