Yao Yan, Zheng Lihui, Zhang Shu, He Ding Sheng, Zhang Kuijun, Tang Min, Chen Keping, Pu Jielin, Wang Fangzheng, Chen Xin
Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Heart Rhythm. 2007 Dec;4(12):1497-504. doi: 10.1016/j.hrthm.2007.07.028. Epub 2007 Aug 11.
This study attempted to convert atrial fibrillation (AF) to sinus rhythm using a stepwise linear catheter ablation approach.
One hundred and ninety-six patients (43 with persistent AF) were enrolled in the study. A multiple electrode array was used for anatomical navigation and activation mapping. Continuously incremental stimulation was used to induce AF if spontaneous AF was not present. Stepwise linear ablation was applied until AF was converted to sinus rhythm or atypical atrial flutter (AAFL) or atrial tachycardia (AT). The stepwise approach initially utilized a figure-7 lesion line between the right and left superior pulmonary vein on the roof of the left atrium and then extended along the ridge between the left appendage and the left pulmonary veins until the mitral valve annulus, as the primary lesions. If AF still persisted, high-frequency potentials in the inferior left atrium, coronary sinus, or right atrium were targeted. Noninducibility of AF was used as the end point.
AF was converted to sinus rhythm in 81.6% of patients (90.8% of paroxysmal and 51.1% of persistent AF, P<.01). The remainders of patients were converted to AAFL or AT. AF was terminated after ablation in right atrium in 7 patients. During an 18.2+/-7.3 month follow-up, 88.3% of patients were free of atrial tachyarrhythmias without medication, 9.7% of patients had refractory AAFL/AT, and only 2.1% of patients had paroxysmal AF.
Stepwise linear ablation is effective in converting AF to sinus rhythm and the figure-7 lesion line should be the basic lesion. Right atrium ablation is necessary in some patients.
本研究试图采用逐步线性导管消融方法将心房颤动（AF）转为窦性心律。
196例患者（43例持续性AF）纳入本研究。使用多电极阵列进行解剖导航和激动标测。若不存在自发性AF，则采用连续递增刺激诱发AF。应用逐步线性消融，直至AF转为窦性心律或非典型心房扑动（AAFL）或房性心动过速（AT）。逐步方法最初在左心房顶部的右上肺静脉和左上肺静脉之间采用7字形消融线，然后沿着左心耳与左肺静脉之间的嵴延伸至二尖瓣环，作为主要消融。若AF仍持续存在，则将左心房下部、冠状窦或右心房中的高频电位作为靶点。以不能诱发AF作为终点。
81.6%的患者AF转为窦性心律（阵发性AF患者中为90.8%，持续性AF患者中为51.1%，P<0.01）。其余患者转为AAFL或AT。7例患者在右心房消融后AF终止。在18.2±7.3个月的随访期间，88.3%的患者无需药物治疗即无房性快速性心律失常，9.7%的患者有难治性AAFL/AT，仅2.1%的患者有阵发性AF。
逐步线性消融可有效将AF转为窦性心律，7字形消融线应为基本消融线。部分患者需要进行右心房消融。
