中华心血管病杂志2005年l1月第33卷第l1期ChinJCardiol。November2005。Vo1．33No．11EnSite—NavX和双Lasso指导下的左心线性消融治疗阵发性心房颤动陈明龙邹建刚徐东杰杨兵陈椿单其俊李闻奇曹克将房．心房颤动研究．【摘要】目的在EnSite-NavX和双Lasso指导下环肺静脉口外线性消融，使肺静脉电活动与心房电活动分离，介绍这一手术方法治疗阵发性心房颤动(房颤)的初步经验。方法2004年4月至11月，共收治22例阵发性房颤患者，其中男性19例，女性3例，年龄25～67(48．5±11．4)岁，房颤病史0．5～13．0(4．3±3．3)年。3例有原发性高血压史，余均无器质性心脏病病史。超声心动图检查示左心房直径为31～46(37．5±4．6)mm。所有患者在建立EnSite-NavX左心房几何构型后，于肺静脉开口外0．5～1．0cm处设置环右侧肺静脉和左侧肺静脉的环状消融线径。盐水灌注导管沿拟定消融线逐点消融，完成右侧消融环线至Lasso电极上肺静脉电位消失；再完成左侧消融环线至肺静脉电位消失。术后服用普罗帕酮450mg／d、培哚普利4mg／d，共3个月。结果22例患者，除1例术中因心包填塞未达消融终点外，余21例均达到消融终点；其中3例于房颤节律时消融，余18例于窦性节律下消融。手术时间5．0—10．0(6．6±1．3)h，X线时间为30～84(56．1±18．0)min。随访3～11(5．3±2．7)个月，10例患者术后症状消失，Hoher示偶见房性早搏。2例经再次手术后未再有房颤发作。3例术后1个月内有阵发性房颤发作，但1个月后未再有发作。2例术后仍有心悸症状，但无房颤发作，Hoher示频繁房性早搏，少数组成短阵房性心动过速；3例仍有房颤发作；1例患者房颤发作更趋频繁。术中共2例发生心包填塞。本研究组总成功率为81％。结论EnSite．NavX和双Lasso指导下的左心房线性消融治疗阵发性房颤具有较高成功率，其长期结果有待于更多病例的积累和更长时间的随访。【关键词】心房颤动；导管消融术；肺静脉LeftatriumlinearlesionencirclingpulmonaryveinsguidedbyEnSite-NavXanddouble··LassotechniqueforparoxysmalatrialfibrillationCHENMing-long，ZOUJian-ng，UDong-jie，^Bing，CHENChun，sHANQi-jun．uWen-qi，CAOKe-jiang．DepartmentofCardiology，FirstAfiliatedHospital，ngMedicalUniversity，，ng210029，ChinaCorrespondingauthor：CAOKe-jiang，Email：kjcao@njmu．edu．cn【Abstract】ObiectiveToevaluatetheeficacyofleftatriumlinearlesionencirclingpulmonaryveins(PV)guidedbyEnSite．NavXanddouble-Lassotechniqueforparoxysmalatrialfibrillation(PAF)．MethodsTwenty-twopatients(male19，meanageof48．5years±11．4years)withsymptomaticPAFwereenroled．AfterageometryoftheleftatriumwasreconstructedbyEnSite．NavXsystem．PVostiaweremarkedonthemapbasedonvenography．TwoLassocatheterswereplacedwithintheipsilateralsuperiorandinferiorPVs．IrrigatedradiofrequencyenergywasaDpliedat0．5—1．0cmofdistancefromthePVostia．Continuouslinearlesionwasdonetoobtainthedisappearanceofpulmonaryveinpotentials．PailentswereonpropafenoneandperindprilfortIlreemonthsafterthepmcedure．ResultsTheendpointforablationwasreachedin21patientsand1patientwasnotsuccessfu1becauseofcardiactamponade．Themeanproceduretimewas6．6h±1．3handthemeanX-rayexposuretimewas56．1min±18．0min．Afteramean5．3months±2．7monthsoffollow．up．10patientswerefreeofsymptoms．TwopatientshadnoPAFrecurrenceafterthesecondpmcedure．ThreepatientshadclinicalrecurrenceofPAFinthefirstmonth．Thetotalsuccessrateinthisstudywas81％(17／21)．Mortalitywas0％andtheoverallcomplicationratewasabout9％(2／22)．ConclusionLeftatriumcircumferentiallinearablationsurroundingPVostiaguidedbyEnsite．NavXanddouble．LassotechniqueisefectiveinPAF．butsomepatientswiIneedmorethanoneprocedurein0rdertoachieveasuccess．【Keywords】Atrialfibrillation；Catheterablation；Pulmonaryveins基金项目...
