Pürerfellner Helmut, Cihal Rudolf, Aichinger Josef, Martinek Martin, Nesser Hans Joachim
Department of Internal Medicine II, St. Elisabeth's Hospital, Linz, Austria.
J Cardiovasc Electrophysiol. 2003 Feb;14(2):158-64. doi: 10.1046/j.1540-8167.2003.02255.x.
The incidence of pulmonary vein (PV) stenosis and its time course for ostial trigger elimination in paroxysmal atrial fibrillation (PAF) is uncertain. In addition, the clinical value of serial computed tomographic (CT) scanning of the PV ostia and the predictive value of energy requirements for radiofrequency ablation have yet to be established.
We performed irrigated-tip ablation in 37 patients with drug-resistant PAF. Serial spiral CT scans were taken prospectively in 34 patients the day before the procedure, at prehospital discharge, and at 3- and 6-month follow-up. Using a clock model, energy requirements were analyzed for every segment of the PV circumference. One hundred fifteen PVs were targeted in 57 procedures. Compared to baseline, 7 (6.08 %) of 115 PV showed minor (<50%) PV stenosis. Two severe (>90%) PV stenoses (1.73%) were detected with a mean follow-up of 275 +/- 100 days. Luminal narrowing occurred most frequently in the left inferior PV (6/9 stenosed PV). Minor stenosed PVs showed their maximal luminal regression within the 3-month follow-up. Two of two PVs with narrowing >50% at 3 months progressed to high-grade stenosis. Analysis of delivered energy showed no significant correlation with the degree of stenosis. However, for the left inferior PV, more energy was applied in the superior segment of a stenotic PV (6697 +/- 930 J vs 3555 +/- 380 J, P = 0.005).
Assessment of PV diameter by serial spiral CT scanning shows a low incidence of severe stenosis. The left inferior PV is at higher risk. Minor stenosed PV showed no progression after 3 months. Occurrence of stenosis tended to be related to the amount of energy delivered.
阵发性心房颤动（PAF）中肺静脉（PV）狭窄的发生率及其消除开口触发灶的时间进程尚不确定。此外，肺静脉开口的系列计算机断层扫描（CT）的临床价值以及射频消融能量需求的预测价值尚未确定。
我们对37例药物难治性PAF患者进行了灌注射频消融。前瞻性地对34例患者在手术前一天、出院前以及3个月和6个月随访时进行了系列螺旋CT扫描。使用时钟模型，分析了肺静脉圆周各段的能量需求。在57例手术中对115条肺静脉进行了靶向治疗。与基线相比，115条肺静脉中有7条（6.08%）出现轻度（<50%）肺静脉狭窄。平均随访275±100天时检测到2例严重（>90%）肺静脉狭窄（1.73%）。管腔狭窄最常发生在左下肺静脉（9条狭窄肺静脉中有6条）。轻度狭窄的肺静脉在3个月随访内显示出最大管腔缩小。3个月时狭窄>50%的2条肺静脉中有2条进展为高度狭窄。分析所输送的能量显示与狭窄程度无显著相关性。然而，对于左下肺静脉，狭窄肺静脉上段施加的能量更多（6697±930焦耳对3555±380焦耳，P = 0.005）。
通过系列螺旋CT扫描评估肺静脉直径显示严重狭窄的发生率较低。左下肺静脉风险较高。轻度狭窄的肺静脉在3个月后无进展。狭窄的发生倾向于与所输送的能量量有关。
