【摘要】 目的　探讨起源于肺静脉的局灶性心房颤动 (房颤 )的电生理特征 ,并对其射频消融治疗的结果进行评价。方法　 38例药物治疗无效的阵发性房颤。常规放置高位右房、冠状静脉窦及左、右上肺静脉同步标测导管电极 ,进行标测。以房性早搏或房颤开始发作时局部双极电位较体表心电图 P’波起点最提前处为消融靶点。结果　起源于肺静脉的局灶性房颤其电生理特征包括 :1异位兴奋灶主要分布于双上肺静脉 (占 87.0 % ) ;2房颤发作呈局灶触发 (87.1 % )和局灶驱动 (1 2 .9% )两种方式 ;3肺静脉内可见递减传导及传导阻滞 ,特别是右上肺静脉。术后随访 0 .5～ 1 8(2 .6± 4.1 )个月 ,1 8例 (47.4% )可以无需药物而维持窦性心律 ;8例 (2 1 .1 % )房颤发作明显减轻 ,且可被术前无效的抗心律失常药物较好控制 ;1 2例 (31 .6 % )无明显改善。并发症 :3例心脏穿孔 ,其中 2例发生心包填塞。术中出现肺静脉狭窄(≥ 5 0 %的直径狭窄 ) 3例 ,随访均无症状。结论　起源于肺静脉的局灶性房颤有其特殊的电生理表现。射频消融治疗对于这类患者虽然方法可行 ,但其安全性和有效性均有待进一步提高。更多还原

【Abstract】 Objective To investigate the electrophysiological characteristics of pulmonary veins with an assessment of the effects of radiofrequency ablation on focal atrial fibrillation (AF) originating from the pulmonary veins. Methods Thirty eight patients with frequent episodes of durg refractory paroxysmal AF were involved in this study.Four multiple electrode catheters were placed for mapping in the high right atrium,coronary sinus,right and left superior pulmonary veins.Radiofrequency energy was delivered at the site where the earliest bipolar activity preceding the onset of ectopic P wave was recorded. Results The electrophysiological characteristics of pulmonary veins included:①left and right superior pulmonary veins were the major sites (87 0%) of ectopic foci;②most episodes(87 1%) of AF were initiated by a single discharge or a sudden burst of rapid depolarization ( focal trigger ),less commonly(12 9%),the surface ECG pattern of AF is due to a focal rapid firing source of activity( focal driver ).③decrmental conduction and conduction block were observed in the pulmonary veins,especially in the right superior pulmonary veins.After a mean follow up of (2 6±4 1)0 5～18 months,AF was eliminated in 18 patients (47 4%)and an additional eight patients(21 1%) required drug therapy which previously were ineffective to suppress the arrhythmia.There were some major complications occurred during the procedure.Three patients had a cardiac perforation with acute cardiac tamponade in two of them.Pulmonary vein stenosis(diameter reduction≥50%)occurred in three patients,but they were asymptomatic during the follow up period.Conclusion AF originating from pulmonary veins had its special electrophsiological characteristics.Radiofrequency ablation for these patients was feasible,but the present technique needs to be improved to elevate its efficacy and safety.更多还原