Ouyang Feifan, Bänsch Dietmar, Ernst Sabine, Schaumann Anselm, Hachiya Hitoshi, Chen Minglong, Chun Julian, Falk Peter, Khanedani Afsaneh, Antz Matthias, Kuck Karl-Heinz
II Medizinische Abteilung, Allgemeines Krankenhaus St. Georg, Hamburg, Germany.
Circulation. 2004 Oct 12;110(15):2090-6. doi: 10.1161/01.CIR.0000144459.37455.EE. Epub 2004 Oct 4.
Paroxysmal atrial fibrillation (PAF) can be eliminated with continuous circular lesions (CCLs) around the pulmonary veins (PVs), but it is unclear whether all PVs are completely isolated.
Forty-one patients with symptomatic PAF underwent 3D mapping, and all PV ostia were marked on the 3D map based on venography. Irrigated radiofrequency energy was applied at a distance from the PV ostia guided by 2 Lasso catheters placed within the ipsilateral superior and inferior PVs. The mean radiofrequency duration was 1550+/-511 seconds for left-sided PVs and 1512+/-506 seconds for right-sided PVs. After isolation, automatic activity was observed in the right-sided PVs in 87.8% and in the left-sided PVs in 80.5%. During the procedure, a spontaneous or induced PV tachycardia (PVT) with a cycle length of 189+/-29 ms was observed in 19 patients. During a mean follow-up of 6 months, atrial tachyarrhythmias recurred in 10 patients. Nine patients underwent a repeat procedure. Conduction gaps in the left CCL in 9 patients and in the right CCL in 2 patients were closed during the second procedure. A spontaneous PVT with a cycle length of 212+/-44 ms was demonstrated in 7 of 9 patients, even though no PVT had been observed in 6 of these 7 patients during the first procedure. No AF recurred in 39 patients after PV isolation during follow-up.
Automatic activity and fast tachycardia within the PVs could reflect an arrhythmogenic substrate in patients with PAF, which could be eliminated by isolating all PVs with CCLs guided by 3D mapping and the double-Lasso technique in the majority of patients.
阵发性心房颤动（PAF）可通过环绕肺静脉（PVs）的连续环形损伤（CCLs）得以消除，但目前尚不清楚所有肺静脉是否均被完全隔离。
41例有症状的PAF患者接受了三维标测，并根据静脉造影在三维图上标记出所有肺静脉口。在置于同侧上、下肺静脉内的2根套索导管引导下，在距肺静脉口一定距离处施加灌注射频能量。左侧肺静脉的平均射频持续时间为1550±511秒，右侧肺静脉为1512±506秒。隔离后，87.8%的右侧肺静脉和80.5%的左侧肺静脉观察到自动活动。在手术过程中，19例患者观察到周期长度为189±29毫秒的自发性或诱发性肺静脉心动过速（PVT）。在平均6个月的随访期间，10例患者出现房性快速心律失常复发。9例患者接受了再次手术。在第二次手术中，9例患者左侧CCL和2例患者右侧CCL中的传导间隙被封闭。9例患者中有7例出现周期长度为212±44毫秒的自发性PVT，尽管这7例患者中有6例在第一次手术期间未观察到PVT。在随访期间，39例患者在肺静脉隔离后未再发生房颤。
肺静脉内的自动活动和快速心动过速可能反映PAF患者的致心律失常基质，通过三维标测和双套索技术引导的CCLs隔离所有肺静脉，在大多数患者中可消除该基质。
