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目的探讨环肺静脉隔离联合碎裂电位单极标测为基础的线性消融治疗长持续性心房颤动的有效性与安全性。方法共8例长时程持续性房颤患者,男6例,女2例,年龄(57.8±8.2)岁,病程(3.4±2.9)年。消融步骤是先行环肺静脉前庭隔离,标测左房碎裂电位QS型分布区,设计消融路线。消融后如未恢复窦律,行电复律,复律后验证肺静脉电位有无恢复及消融线的完整性。消融终点为双肺静脉电位隔离及消融线双向阻滞。术后所有患者均给予服用可达龙口服0.6g/d连续1周,继之0.4g/d连续1周,以后0.2g/d,共6个月;华法林抗凝6个月,如无复发可停用。术后第1、3、6、12月行动态心电图检查。结果消融术中8例行电复律转复为窦律。8例均实现双侧肺静脉电隔离,消融线完整,随访6-24个月,动态心电图无房速、房扑、房颤复发。结论长时程持续性房颤患者,环肺静脉隔离联合碎裂电位单极标测为基础的线性消融能够破坏更多的维持机制,是治疗长时程持续性房颤的安全、有效的方法。
Objective To investigate the effectiveness and safety of linear ablation based on unilaterally labeled pulmonary vein isolation combined with fragmentation potential in the treatment of long-lasting atrial fibrillation. Methods A total of 8 long-term persistent atrial fibrillation patients, 6 males and 2 females, aged (57.8 ± 8.2) years, duration (3.4 ± 2.9) years. Ablation procedure is the first anterior pulmonary veins vestibular isolation, mapping left atrial fragmentation potential QS-type distribution area, design ablation route. After ablation, if the sinus rhythm is not restored, the cardioversion is performed and the pulmonary venous potential is recovered and the integrity of the ablation line verified after cardioversion. End point for the ablation of pulmonary vein potential isolation and two-way ablation block. All patients were given up to 0.6g / d orally for 1 week, followed by 0.4g / d for 1 week, 0.2g / d after a total of 6 months; warfarin for 6 months without recurrence Can be disabled. Postoperative 1, 3, 6, December, dynamic ECG. Results 8 cases of ablation cardioversion retrograde sinus law. 8 cases were achieved bilateral pulmonary vein electrical isolation, complete ablation line, followed up for 6-24 months, no ambulatory ECG, atrial flutter, atrial fibrillation recurrence. Conclusions Linear ablation based on unilaterally labeled pulmonary vein isolation combined with fragmentation potential can destroy more maintenance mechanisms in patients with long-term persistent AF and is a safe and effective method for the treatment of long-term persistent atrial fibrillation.