目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式...目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式改进分为三组CPVI+CFAEs、CPVI+linear和CPVI+CFAEs+Linear组。比较消融术中房颤终止比例及随访疗效。结果三组消融总时间有显著性差异(160±14 min vs 178±9 min vs 241±8min,P<0.01)。CPVI+CFAEs组终止房颤/转变房性心动过速(简称房速)的比例(52.7%)显著高于CPVI+Line-ar组(18.4%),但低于CPVI+CFAEs+Linear组(73.1%)。术后3.1±1.2个月,三组二次消融比例47.3%、51%、38.5%,P=0.43。术后平均随访9.5±1.8个月,三组无房性快速性心律失常复发例数分别为39例(70.9%)、33例(67.3%)和41例(78.8%),P=0.41(服用抗心律失常药物比例25.6%、24.2%和22%,P=0.96)。结论 CP-VI基础上CFAEs消融的房颤终止比例高于单纯线性消融,但低于联合应用CFAEs消融和Linear消融。尽管如此,三组术后二次消融比例和随访成功率无显著性差异。展开更多
Background -This prospective clinical study evaluates the feasibility and eff icacy of combined linear mitral isthmus ablation and pulmonary vein(PV) isolatio n in patients with paroxysmal atrial fibrillation(AF). Met...Background -This prospective clinical study evaluates the feasibility and eff icacy of combined linear mitral isthmus ablation and pulmonary vein(PV) isolatio n in patients with paroxysmal atrial fibrillation(AF). Methods and Results -One hundred consecutive patients(13 women; age 55±10 years)-with drug-refractory , symptomatic paroxysmal AF underwent PV isolation and linear ablation of the ca votricuspid isthmus and the mitral isthmus(lateral mitral annulus to the left in ferior PV). They were compared with 100 consecutive patients(14 women; age, 52± 10 years) undergoing PV isolation and cavotricuspid ablation without mitral isth mus ablation. Bidirectional mitral isthmus block was confirmed by demonstrating( 1) a parallel corridor of double potentials during coronary sinus(CS) pacing,(2) an activation detour by pacing either side of the line, and(3) differential pac ing techniques. Isolation of all PVs and cavotricuspid isthmus ablation were per formed successfully in all. Mitral isthmus block was achieved in 92 patients aft er 20±10 minutes of endocardial radiofrequency application and an additional 5 ±4 minutes of epicardial radiofrequency application from within the CS in 68, r esulting in a conduction delay of 151±26 ms during CS pacing. Thirty-two patie nts with mitral isthmus ablation compared with 49 without had recurrent atrial a rrhythmia (P=0.02) requiring further ablation. At 1 year after the last procedur e, 87 patients with mitral isthmus ablation and 69 without(P=0.002) were arrhyth mia free without antiarrhythmic drugs, mitral isthmus ablation being the only fa ctor associated with long-term success(RR for AF recurrence, 0.2; CI, 0.1 to 0. 4; P< 0.001). Conclusions -Catheter ablation of the mitral isthmus results cons istently in demonstrable conduction block and is associated with a high cure rat e for paroxysmal AF.展开更多
文摘目的评价环肺静脉隔离(CPVI)基础上采用心房碎裂电位(CFAEs)消融或(和)线性(Linear)消融进行心房基质改良的疗效。方法回顾性分析156例慢性心房颤动(简称房颤)消融病例,房颤病程2.5±2.3年,左房内径42.4±4.5 mm。根据消融术式改进分为三组CPVI+CFAEs、CPVI+linear和CPVI+CFAEs+Linear组。比较消融术中房颤终止比例及随访疗效。结果三组消融总时间有显著性差异(160±14 min vs 178±9 min vs 241±8min,P<0.01)。CPVI+CFAEs组终止房颤/转变房性心动过速(简称房速)的比例(52.7%)显著高于CPVI+Line-ar组(18.4%),但低于CPVI+CFAEs+Linear组(73.1%)。术后3.1±1.2个月,三组二次消融比例47.3%、51%、38.5%,P=0.43。术后平均随访9.5±1.8个月,三组无房性快速性心律失常复发例数分别为39例(70.9%)、33例(67.3%)和41例(78.8%),P=0.41(服用抗心律失常药物比例25.6%、24.2%和22%,P=0.96)。结论 CP-VI基础上CFAEs消融的房颤终止比例高于单纯线性消融,但低于联合应用CFAEs消融和Linear消融。尽管如此,三组术后二次消融比例和随访成功率无显著性差异。
文摘Background -This prospective clinical study evaluates the feasibility and eff icacy of combined linear mitral isthmus ablation and pulmonary vein(PV) isolatio n in patients with paroxysmal atrial fibrillation(AF). Methods and Results -One hundred consecutive patients(13 women; age 55±10 years)-with drug-refractory , symptomatic paroxysmal AF underwent PV isolation and linear ablation of the ca votricuspid isthmus and the mitral isthmus(lateral mitral annulus to the left in ferior PV). They were compared with 100 consecutive patients(14 women; age, 52± 10 years) undergoing PV isolation and cavotricuspid ablation without mitral isth mus ablation. Bidirectional mitral isthmus block was confirmed by demonstrating( 1) a parallel corridor of double potentials during coronary sinus(CS) pacing,(2) an activation detour by pacing either side of the line, and(3) differential pac ing techniques. Isolation of all PVs and cavotricuspid isthmus ablation were per formed successfully in all. Mitral isthmus block was achieved in 92 patients aft er 20±10 minutes of endocardial radiofrequency application and an additional 5 ±4 minutes of epicardial radiofrequency application from within the CS in 68, r esulting in a conduction delay of 151±26 ms during CS pacing. Thirty-two patie nts with mitral isthmus ablation compared with 49 without had recurrent atrial a rrhythmia (P=0.02) requiring further ablation. At 1 year after the last procedur e, 87 patients with mitral isthmus ablation and 69 without(P=0.002) were arrhyth mia free without antiarrhythmic drugs, mitral isthmus ablation being the only fa ctor associated with long-term success(RR for AF recurrence, 0.2; CI, 0.1 to 0. 4; P< 0.001). Conclusions -Catheter ablation of the mitral isthmus results cons istently in demonstrable conduction block and is associated with a high cure rat e for paroxysmal AF.
