Ma Jian, Tang Kai, Ma Fu-sheng, Jia Yu-he, Zhang Shu, Huang Cong-xin
Department of Cardiology, People's Hospital, Wuhan University, Wuhan 430063, China.
Chin Med J (Engl). 2006 Dec 20;119(24):2042-8.
Linear ablation of left atrium (LA) guided by three dimensional (3-D) electroanatomical mapping (Carto) has been used in many centres worldwide for the treatment of atrial fibrillation (AF) instead of pure anatomical approaches. There were little data about linear ablation of LA guided by Carto and double Lasso catheters in China. We report the results of linear ablation of LA guided by both Carto and double Lasso catheters.
After the anatomical model of LA and all pulmonary veins (PVs) had been established, circumferential ablations of the left pulmonary vein antrum and the right pulmonary vein antrum were performed with 2 circumferential mapping catheters (Lasso) placed within the ipsilateral superior and inferior PVs. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials (PVPs). Oral amiodarone or propafenone was taken for at least 3 months by patients with persistent AF, permanent AF or those whose PVPs had not been isolated completely. The recurrence of atrial tachyarrhythmias was observed 3 months after the procedure.
There were 106 patients (mean age, 51.4 +/- 9.9 years). Seventy-eight patients had paroxysmal AF, 12 persistent AF and 16 permanent AF. Onset of atrial fibrillation occurred in 52 patients during ablation procedure. Thirty-two patients restored to sinus rhythm eventually after the procedure. Abolishment or dissociation of PVPs was accomplished during the procedure in 94 patients (88.7%). The duration of procedure and exposure to X-ray were (213 +/- 45) minutes and (32.5 +/- 12.8) minutes, respectively. Among the 87 patients followed up for over 3 months, 62 were free of atrial tachyarrhythmias (including 8 patients who were still taking oral amiodarone). The success rate was 71.3% in the first procedure. Two patients had pericardial effusion treated by pericardial puncture and effusion drainage. No pulmonary vein stenosis, atrioesophageal fistula, stroke or procedural death occurred.
Combination of double Lasso catheters with 3-D electroanatomical mapping to guide the linear ablation of left atrium procedure can confirm the isolation of PVPs.
在全球许多中心，三维（3-D）电解剖标测（Carto）指导下的左心房（LA）线性消融已被用于治疗心房颤动（AF），而非单纯的解剖学方法。在中国，关于Carto和双Lasso导管指导下的LA线性消融的数据很少。我们报告了Carto和双Lasso导管指导下的LA线性消融结果。
在建立LA和所有肺静脉（PVs）的解剖模型后，使用放置在同侧上下PVs内的2根环形标测导管（Lasso）对左肺静脉前庭和右肺静脉前庭进行环形消融。消融终点为肺静脉电位（PVPs）的消除或分离。持续性AF、永久性AF患者或PVPs未完全隔离的患者口服胺碘酮或普罗帕酮至少3个月。术后3个月观察房性快速心律失常的复发情况。
共106例患者（平均年龄51.4±9.9岁）。78例为阵发性AF，12例为持续性AF，16例为永久性AF。52例患者在消融过程中发生房颤。32例患者术后最终恢复窦性心律。94例患者（88.7%）在术中实现了PVPs的消除或分离。手术时间和X线暴露时间分别为（213±45）分钟和（32.5±12.8）分钟。在87例随访超过3个月的患者中，62例无房性快速心律失常（包括8例仍在口服胺碘酮的患者）。首次手术成功率为7%.2例患者发生心包积液，经心包穿刺引流治疗。未发生肺静脉狭窄、心房食管瘘、中风或手术死亡。
双Lasso导管与三维电解剖标测相结合指导左心房线性消融手术可确认PVPs隔离。
