Kumagai Koichiro, Noguchi Hiroo, Ogawa Masahiro, Nakashima Hideko, Zhang Bo, Miura Shin-ichiro, Saku Keijiro
Department of Cardiology, Fukuoka University Hospital, Japan.
Circ J. 2006 Jan;70(1):88-93. doi: 10.1253/circj.70.88.
Pulmonary vein (PV) isolation using a circular catheter creates an entrance block from the left atrium (LA) to the PV, which eliminates paroxysmal atrial fibrillation (PAF). A new approach to PV isolation during distal PV pacing is to use a basket catheter.
Fifty consecutive patients with PAF underwent basket-catheter-guided PV isolation. PV pacing was performed from the distal electrode pair of the basket catheter. The exit breakthrough point was targeted for segmental PV isolation. The endpoint was the elimination of bidirectional PV - LA conduction. A repeat ablation procedure was performed in 12 of 14 patients who had recurrence of AF. The recovery of PV -LA conduction was noted in 24 of the 48 PVs, and 5 PVs (21%) had unidirectional block. At 12 months, 80% of patients were free of AF without antiarrhythmic drugs. No PV stenosis >50% was detected at 12 months after the procedure.
This new approach for PV isolation during distal PV pacing using a basket catheter is useful for confirming bidirectional PV - LA conduction block. PV isolation that creates not only an entrance block but also an exit block at the PV - LA junction may be required to cure paroxysmal AF.
使用环形导管进行肺静脉（PV）隔离可形成从左心房（LA）到PV的入口阻滞，从而消除阵发性心房颤动（PAF）。在肺静脉远端起搏期间进行肺静脉隔离的一种新方法是使用篮状导管。
连续50例阵发性房颤患者接受了篮状导管引导下的肺静脉隔离。通过篮状导管的远端电极对进行肺静脉起搏。将出口突破点作为节段性肺静脉隔离的靶点。终点是消除肺静脉-左心房的双向传导。14例房颤复发患者中有12例接受了再次消融手术。48条肺静脉中有24条出现肺静脉-左心房传导恢复，5条肺静脉（21%）出现单向阻滞。在12个月时，80%的患者在未使用抗心律失常药物的情况下未发生房颤。术后12个月未检测到肺静脉狭窄>50%。
这种在肺静脉远端起搏期间使用篮状导管进行肺静脉隔离的新方法有助于确认肺静脉-左心房的双向传导阻滞。治愈阵发性房颤可能需要在肺静脉-左心房交界处不仅形成入口阻滞，而且形成出口阻滞的肺静脉隔离。
