Hoff Per Ivar, Chen Jian, Erga Knut Ståle, Rossvoll Ole, Ohm Ole-Jørgen
Hjerteavdelingen Haukeland, Universitetssykehus, 5021 Bergen.
Tidsskr Nor Laegeforen. 2004 Mar 4;124(5):625-8.
Atrial fibrillation is associated with increased morbidity and twice the mortality compared to individuals without fibrillation. Treatment with antiarrhythmic drugs has limited effect in paroxysmal atrial fibrillation.
The group of patients comprised 59 men and 13 women with an average age of 51 +/- 10, the majority of whom had failed several drug regimens; some had undergone repeated DC conversions. A new method based on radiofrequency ablation and isolation of pulmonary veins from the left atrium may offer curative treatment for paroxysmal atrial fibrillation. The basis for this method is that foci in or close to the pulmonary veins initiate or drive atrial fibrillation. These foci may be identified by transseptal access to the left atrium and isolation of the veins from the left atrium using radiofrequency energy.
The group of 72 patients underwent 86 procedures. Foci were observed in 65.3%. Isolation of 3.1 +/- 0.9 veins was performed in 71 patients. During a follow up period of 10.3 +/- 5.1 months, 60.9% reported absence of fibrillation and 81.2% reported cure or considerable improvement. Complications included drainage of pericardial effusion in one patient, cerebral embolus with partial visual impairment in one patient, and an asymptomatic pulmonary vein stenosis in one patient.
Paroxysmal atrial fibrillation can be treated in selected patients using pulmonary vein isolation with low to moderate risk of complications. Longer follow up is necessary for full evaluation of effect.
与无房颤的个体相比，房颤与发病率增加及死亡率翻倍相关。抗心律失常药物治疗阵发性房颤的效果有限。
患者组包括59名男性和13名女性，平均年龄51±10岁，其中大多数人多种药物治疗方案均失败；一些人曾多次接受直流电复律。一种基于射频消融和从左心房隔离肺静脉的新方法可能为阵发性房颤提供治愈性治疗。该方法的依据是肺静脉内或其附近的病灶引发或驱动房颤。这些病灶可通过经房间隔进入左心房并使用射频能量将肺静脉与左心房隔离来识别。
72例患者接受了86次手术。65.3%观察到病灶。71例患者隔离了3.1±0.9条肺静脉。在10.3±5.1个月的随访期内，60.9%的患者报告无房颤，81.2%的患者报告治愈或有显著改善。并发症包括1例患者心包积液引流、1例患者脑栓塞伴部分视力损害和1例患者无症状性肺静脉狭窄。
对于部分患者，采用肺静脉隔离治疗阵发性房颤并发症风险低至中度。为全面评估疗效，需要更长时间的随访。
