Maeda Shingo, Iesaka Yoshito, Otomo Kiyoshi, Uno Kikuya, Nagata Yasutoshi, Suzuki Kenji, Hachiya Hitoshi, Goya Masahiko, Takahashi Atsushi, Fujiwara Hideomi, Isobe Mitsuaki
Department of Cardiology, Musashino Red Cross Hospital, 1-26-1 Sakai-Minami, Musashino, Tokyo 180-8610, Japan.
Heart Vessels. 2011 Jul;26(4):440-8. doi: 10.1007/s00380-010-0073-5. Epub 2010 Dec 4.
Few studies have explored the utility of local electrogram-guided extensive encircling pulmonary vein isolation (EEPVI) by analyzing the pulmonary vein (PV) anatomy and occurrence of stenosis using multidetector computed tomography (MDCT). One hundred seventy-six paroxysmal atrial fibrillation (AF) patients underwent EEPVI with a double lasso technique. MDCT was performed in all patients before and at 3, 6 and 12 months after the ablation procedures to screen for PV stenosis. PV stenosis was defined as a >30% reduction in its diameter. A total of 700 PVs were analyzed. PV stenosis was observed in 15 of 700 PVs (2.1%). All stenoses were mild (mean 34.5 ± 3.3%). They were all asymptomatic, and none required treatment. After 12 months of follow-up, the PV narrowing regressed significantly compared with that at 3 months in the patients with PV stenosis (34.5 ± 3 to 30.4 ± 5%, P < 0.05). The remaining PVs exhibited a stable anatomy, and there was no significant progression of the PV narrowing. The results of this study demonstrated that detectable PV stenosis occurred in 2.1% of the PVs, and all stenoses were mild. Moreover, a significant regression of the PV narrowing was observed after 12-months of follow-up. This indicates that the local electrocardiogram-guided EEPVI was relatively safe regarding severe PV stenosis.
很少有研究通过多排螺旋计算机断层扫描（MDCT）分析肺静脉（PV）解剖结构和狭窄发生率来探索局部心内电图引导下的广泛环绕肺静脉隔离术（EEPVI）的效用。176例阵发性心房颤动（AF）患者采用双套索技术进行了EEPVI。在所有患者消融术前以及术后3、6和12个月进行MDCT检查以筛查PV狭窄。PV狭窄定义为其直径缩小>30%。共分析了700条PV。700条PV中有15条（2.1%）观察到PV狭窄。所有狭窄均为轻度（平均34.5±3.3%）。它们均无症状，无一需要治疗。随访12个月后，PV狭窄患者的PV狭窄程度与3个月时相比显著减轻（34.5±3至30.4±5%，P<0.05）。其余PV解剖结构稳定，PV狭窄无明显进展。本研究结果表明，2.1%的PV出现可检测到的PV狭窄，且所有狭窄均为轻度。此外，随访12个月后观察到PV狭窄显著减轻。这表明局部心电图引导下的EEPVI在严重PV狭窄方面相对安全。
