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目的心房颤动(房颤,AF)的发生和维持可能存在多种机制,对所有的AF都以一种固定的术式进行消融治疗缺乏针对性。为此,我们采用心内非接触式标测,探索个体化消融的可行性。方法52例患者(男性44例,女性8例),年龄22～70(51.1±10.9)岁,左心房内径22～54(36.1±6.5)mm,其中12例为持续性AF(1～22年)。均经房间隔穿刺在左心房内对AF进行非接触式等电位标测,并在等电位标测下逐步进行个体化消融,消融术式不固定,以AF被终止且不被诱发、消融线形成双向阻滞为消融终点。结果AF被分为3种类型,而肺静脉(pulmonaryvein,PV)口周围、左心房顶部是波阵面的主要传导区。消融方式根据标测结果决定,包括在以上任一部位的线性消融、环PV口外的线性消融等,其中持续性AF多形成绕PV口周的环形消融加左心房顶部消融线。82.7%(43/52)的AF被消融所终止且不能再诱发,其中4例需在右心房消融方成功;另有5例的AF被转变为左心房扑动(房扑)。首次消融的即时成功率为90.4%(47/52)。消融中1例有心脏压塞。6例首次消融后有左心房房扑的患者再次接受了消融,标测发现既往消融线存在缝隙,针对缝隙消融后心动过速均被终止且不能被诱发。平均随访(11.0±6.2)个月,术后3个月82.7%(43/52)的患者不服药物亦无AF发生,其中阵发性AF成功率为87.5%(35/40);持续性AF为66.7%(8/12),其余患者均转为左心房房扑。结论本组结果初步提示,在非接触式等电位标测的基础上进行个体化的心房电学改良消融可有效地终止AF并有较好的中期疗效。其远期的效果有待观察。
Purpose Atrial fibrillation (atrial fibrillation, AF) may occur with the occurrence and maintenance of a variety of mechanisms, all of AF are absent in a fixed surgical ablation. To this end, we use intracardiac non-contact mapping to explore the feasibility of individual ablation. Methods Fifty-two patients (44 males and 8 females) aged 22-70 (51.1 ± 10.9) years and left atria with diameters of 22-54 (36.1 ± 6.5) mm, of whom 12 were persistent AF (1- 22 years ). Atrial septum puncture AF in the left atrial non-contact equipotential mapping, and gradually under the potential of the potential of individualized ablation, ablation is not fixed to AF was terminated and not be induced ablation line The formation of two-way block for the ablation end point. Results AF was divided into three types. However, the pulmonary veins around the mouth and the top of the left atrium were the major conductive areas of the wavefront. Ablation methods based on mapping results, including linear ablation in any of the above parts, linear PV outside the mouth of the ablation, etc., in which the formation of persistent multiple around the PV perirenal ablation plus left atrial top ablation line. AF was ablated in 82.7% (43/52) of the patients and no further induction was achieved. Four of the AFs were successful in the right atrial ablation procedure and another five were converted to left atrial flutter (AF). The immediate success rate of first ablation was 90.4% (47/52). Ablation in 1 case of cardiac tamponade. Six patients with left atrial flutter after first ablation were receptive again, and the mapping found that there was a gap in the past ablation line. Tachycardia after ablation was terminated and could not be induced. The patients were followed up for an average of (11.0 ± 6.2) months and 82.7% (43/52) at 3 months postoperatively. There were no drug-induced or AF-induced AF, with a success rate of 87.5% (35/40) for paroxysmal AF. Persistent AF 66.7% (8/12), the remaining patients were converted to left atrial flutter. Conclusions The results of this group suggest that the individualized atrial electrical improvement and ablation based on the non-contact equipotential mapping can effectively terminate AF and have a good mid-term efficacy. The long-term effect remains to be seen.