Calò Leonardo, Lamberti Filippo, Loricchio Maria Luisa, Castro Antonio, Shpun Shlomo, Boggi Augusto, Pandozi Claudio, Santini Massimo
Department of Cardiac Diseases, San Filippo Neri Hospital, Rome, Italy.
J Cardiovasc Electrophysiol. 2004 Jan;15(1):37-43. doi: 10.1046/j.1540-8167.2004.03264.x.
The aim of this study was to evaluate the efficacy and the impact on quality of life of a new ablative approach to the right atrium in patients with atrial fibrillation (AF).
Seventy-four symptomatic patients with paroxysmal (n = 49) or permanent (n = 25) refractory AF underwent radiofrequency ablation. A nonfluoroscopic electroanatomic mapping system was used to perform the following lesions: (1) an isthmus line between the tricuspid annulus and the inferior vena cava; (2) a posterior intercaval line from the superior vena cava and the inferior vena cava; (3) a septal line from the superior vena cava to the fossa ovalis, proceeding to the coronary sinus ostium where a circumferential line around the ostium was performed, and then on to the inferior vena cava; and (4) a transversal lesion connecting the posterior intercaval and the septal lesions. In addition, electrical disconnection of the superior vena cava was performed. There were no complications. Postablation remapping showed the absence of discrete electrical activity inside and just around the ablation lines. Electrical disconnection of the superior vena cava was obtained in all patients. After 21 +/- 6 months, 49 patients (66%) had stable sinus rhythm with continuation of the previous antiarrhythmic drug therapy, 13 patients (18%) were considered improved, and 12 (16%) received no benefit (unsuccessful procedure). After ablation, quality of life was significantly improved, reaching the levels of the general Italian population. Ejection fraction and the extent of the low-voltage area were found by multivariate analysis to be independent predictors of AF recurrence.
The results of the present study suggest that this ablative approach in combination with antiarrhythmic drugs is safe and effective in treating AF, leading to a marked increase in quality of life in patients with refractory AF.
本研究旨在评估一种针对心房颤动（AF）患者右心房的新型消融方法的疗效及其对生活质量的影响。
74例有症状的阵发性（n = 49）或永久性（n = 25）难治性AF患者接受了射频消融。使用非透视性电解剖标测系统进行以下消融：（1）三尖瓣环与下腔静脉之间的峡部线；（2）从上腔静脉至下腔静脉的后腔间线；（3）从上腔静脉至卵圆窝的间隔线，延伸至冠状窦口，在窦口周围进行环线消融，然后继续至下腔静脉；（4）连接后腔间与间隔消融灶的横向消融灶。此外，还进行了上腔静脉电隔离。无并发症发生。消融后重标测显示消融线内及紧邻消融线处无离散电活动。所有患者均实现了上腔静脉电隔离。21±6个月后，49例患者（66%）维持稳定窦性心律并继续使用先前的抗心律失常药物治疗，13例患者（18%）病情改善，12例患者（16%）未获益（手术失败）。消融后，生活质量显著改善，达到意大利普通人群水平。多因素分析发现射血分数和低电压区范围是AF复发的独立预测因素。
本研究结果表明，这种消融方法联合抗心律失常药物治疗AF安全有效，可显著提高难治性AF患者的生活质量。
