协和医学杂志

2010, v.1(02) 160-166

[打印本页] [关闭]
本期目录(Current Issue) | 过刊浏览(Past Issue) | 高级检索(Advanced Search)

持续性心房颤动导管消融术强化间隔消融与术后左心耳激动延迟的关系
Relationship between Aggressive Septal Ablation and Significant Left Atrial Appendage Activation Delay following Catheter Ablation of Persistent Atrial Fibrillation

蒋晨曦;马长生;董建增;刘兴鹏;龙德勇;喻荣辉;汤日波;吴佳慧;桑才华;宁曼;刘小慧;
JIANG Chen-xi,MA Chang-sheng,DONG Jian-zeng,LIU Xing-peng,LONG De-yong,YU Rong-hui,TANG Ri-bo,WU Jia-hui,SANG Cai-hua,NING Man,LIU Xiao-hui Department of Cardiology,Center for Atrial Fibrillation Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China

摘要(Abstract):

目的探讨持续性心房颤动(简称房颤)导管消融术后左心耳激动显著延迟与术中强化间隔消融的关系。方法对2007年6月至2009年2月在本科接受导管消融术的201例持续性房颤患者行步进式导管消融,术后行左房激动标测并记录左心耳电活动,术后1月行经胸心脏超声评估左房功能。结果术后23例出现左心耳激动显著延迟,其中14例为初次消融病例,9例接受了间隔线消融(OR15.2,95%CI4.6~50.8,P<0.001);另9例为第2次消融(包括2例左房隔离)病例,9例患者也于初次消融中行广泛间隔复杂碎裂电位消融(P=0.002)。激动标测提示21例患者中18例(85.7%)左房最早激动部位转向冠状窦。术后1个月二尖瓣前向血流A峰为(18.2±17.0)cm/s,与术前为窦性心律者比较显著下降,(20.2±19.1)cm/svs.(58.2±17.9)cm/s(P=0.037)。随访(10.6±6.2)个月,14例患者维持窦性心律。结论持续性房颤导管消融术行间隔线或广泛间隔复杂碎裂电位消融可导致左心耳激动显著延迟,可能影响左房功能,持续性房颤患者采用此术式应该慎重。
Objective To elucidate the significant left atrial appendage activation following ablation of persistent atrial fibrillation,and explore its relationship with aggressive septal ablation. Methods A total of 201 patients with persistent atrial fibrillation underwent catheter ablation from June 2007 to February 2009. Action mapping of left atrium was performed and the local potential of left atrial appendage was recorded at the end of the procedure. Transthroacic ultrasound was performed one month later to evaluate the function of left atrium. Results Significant left atrial appendage activation delay was found in 23 out of 201 patients undergoing persistent atrial fibrillation ablation. Of these 23 patients,14 patients suffered from this condition in their first were found at index procedures,of whom septal line ablation was performed in nine (odds ratio 15.2,95% confidence interval 4.6-50.8,P<0.001). The delay was found in another 9 patietns during their redo procedures (including two with biatrial activation dissociation),all of whom received extensive left septal complex fractionated elegrams ablation in their prior procedures (P=0.002). Activation mapping demonstrated the earliest breakthrough of the left atrium changed to coronary sinus in 18 (85.7%) patients. After 1 month,the mitral A wave velocity was 18.2±17.0 cm/s,and decreased significantly as compared with preablation (20.2±19.1 vs. 58.2±17.9 cm/s,P=0.037) in patients undergoing redo procedures. Fourteen (60.9%) remained arrhythmia-free during follow-up,which lasted 10.6 ± 6.2 months. Conclusion Septal line ablation and extensive septal complex fractionated elegrams ablation are correlated with significant left atrial activation delay or even biatrial activation dissociation,and should be performed with prudent consideration.

关键词(KeyWords): 心房颤动;消融;激动延迟,左心耳
atrial fibrillation;ablation;activation delay,left atrial appendage

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 蒋晨曦;马长生;董建增;刘兴鹏;龙德勇;喻荣辉;汤日波;吴佳慧;桑才华;宁曼;刘小慧;
JIANG Chen-xi,MA Chang-sheng,DONG Jian-zeng,LIU Xing-peng,LONG De-yong,YU Rong-hui,TANG Ri-bo,WU Jia-hui,SANG Cai-hua,NING Man,LIU Xiao-hui Department of Cardiology,Center for Atrial Fibrillation Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China

Email:

DOI:

参考文献(References):

扩展功能
本文信息
服务与反馈
本文关键词相关文章
本文作者相关文章
中国知网
分享