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目的 探讨经导管射频消融治疗阵发性心房颤动 (房颤 )的安全性和有效性。方法 74例发作频繁、药物治疗无效的阵发性房颤 ,前 5 0例的消融靶点为房颤特异性早搏或房颤的起源部位 ,消融终点为自发和诱发的房颤特异性早搏或房颤消失 (终点 1) ;后 2 4例的消融靶点为致心律失常性肺静脉的开口部 ,消融终点为该肺静脉的肺静脉电位消失 (终点 2 )。结果 共发现 111个异位灶 ,行76次消融术 ,有 5 8例 (78 4% )达到消融终点。随访 1～ 31(12 9± 6 6 )个月 ,2 3例 (31 1% )消融成功 ,可以无需药物而维持窦性心律。术中达到消融终点者的成功率为 39 7% (2 3例 / 5 8例 ) ,其中达终点 1者为 34 1% (15例 / 44例 ) ,达终点 2者为 5 7 1% (8例 / 14例 )。并发症 :无症状的单支肺静脉狭窄 5例(6 8% )、气胸 1例 (1 4% ) ,均发生于本组的前 30例中。结论 经导管射频消融治疗阵发性房颤较为安全 ,但成功率尚待提高 ,目前可用于部分发作频繁、症状严重、而且药物治疗无效的患者。
Objective To investigate the safety and efficacy of transcatheter radiofrequency ablation of paroxysmal atrial fibrillation (AF). Methods A total of 74 patients with paroxysmal atrial fibrillation who had frequent seizures and drug therapy were excluded. The first 50 ablation targets were the origin of AF-specific premature beats or atrial fibrillation. The ablation end points were spontaneous and induced atrial fibrillation-specific premature beats or Atrial fibrillation disappeared (end point 1); the latter 24 ablation targets were open to the arrhythmogenic pulmonary veins whose end disappearance of the pulmonary venous potential (end point 2). Results A total of 111 ectopic foci were found and 76 ablations were performed. Fifty eight patients (78 4%) reached the end of ablation. After a follow-up of 1-31 (12 9 ± 6 6) months, 23 (31.1%) ablations were successful and sinus rhythm was maintained without medication. The successful rate of end-to-end ablation was 39.7% (23 cases / 58 cases), of which 34.1% (15 cases / 44 cases) reached the end point and 57.1% 8 cases / 14 cases). Complications: Asymptomatic single pulmonary vein stenosis in 5 cases (68%), pneumothorax in 1 case (14%), occurred in the group of the first 30 cases. Conclusions Transcatheter radiofrequency catheter ablation of paroxysmal atrial fibrillation is safe, but the success rate needs to be improved. It is currently used in patients with frequent seizures, severe symptoms and ineffective drug treatment.