【摘要】 目的研究心房颤动(房颤)患者环肺静脉左心房线性消融术后复发房性心律失常的机制。方法28例房颤患者接受环肺静脉左心房线性消融术,平均年龄(54±11)岁,其中阵发性房颤10例,持续性房颤18例。采用Carto电解剖标测系统及双Lasso标测导管技术,分别进行环左、右侧肺静脉线性消融;消融终点为肺静脉电位消失,左心房-肺静脉双向阻滞。复发患者再次消融术采用双Lasso导管指导在原环形消融线上标测“漏点”并消融封闭之,对不能终止心动过速者再行拖带标测、激动标测或结合Carto系统标测;对典型心房扑动(房扑)行右心房峡部线性消融。结果初次消融术后平均随访(245±65)d,18例无复发;8例复发房性心律失常包括5例典型房扑、2例其他房性心动过速、1例阵发性房颤;2例左上肺静脉电位未完全隔离者仍持续房颤。除外1例持续性房颤,另外9例接受了再次消融术,证实所有复发患者均有左心房-肺静脉传导恢复;8例射频消融成功并随访(192±92)d无复发。结论左心房-肺静脉传导恢复是环肺静脉左心房线性消融术后复发房性心律失常的重要因素;初次手术附加右心房峡部线性消融可能减少复发率。更多还原

【Abstract】 Objective To investigate the probable mechanism of recurrent atrial tachyarrhymias after left atrial linear ablation surrounding ipsilateral pulmonary veins(PVs). Methods Ten patients with paroxysmal atrial fibrillation(AF) and 18 patients with persistent AF underwent left atrial linear ablation surrounding ipsilateral PVs guided by Carto electroanatomic mapping system and double Lasso catheters technique. The end point of ablation was defined as absence of all PV spikes documented with the 2 Lasso catheters within the ipsilateral PVs at least 30 minutes after isolation and bidirectional conduction block between left atrial and PVs. For the patients with recurrent atrial tachyarrhymias, double Lasso technique was used to find the gap of the original circle lines in the repeat ablation. Activation mapping and entrainment mapping were performed with or without Carto system to identify the earliest activated area or reentrant circuit. Cavotricuspid isthmus was ablated for patients with documented commen-type atrial flutter(AFL). Results After a median of (245±65) days of follow-up, eighteen patients were free of AF with or without antiarrhythmic drugs. Two patients with persistent AF remaining PV spikes in left superior PV failured being translated to sinus rhythm by cardioversion.Eight patients with recurrent atrial tachyarrhymias, including5 typical AFL, two atrial tachycardia and 1 parox-ysmal AF, underwent repeat ablation. Recovered conduction between left atrium and PVs were documented inall of them. Except1 patient with atrial tachycardia related to both atria, all the other8 patients were cured bythe second procedure and free of atrial tachyarrhythmia after (192±92) days follow-up.Conclusion Recov-ered conduction between left atrium and PVs was an important factor for the recurrent atrial tachyarrhytmia afterleft atrial linear ablation and additional ablation lines on cavotricuspid isthmus in the initial procedure could re-duce the secondary atrial tachycardia.更多还原