Intracardiac echocardiography-guided, anatomically based radiofrequency ablationof focal atrial fibrillation originating from pulmonary veins
Intracardiac echocardiography-guided, anatomically based radiofrequency ablationof focal atrial fibrillation originating from pulmonary veins
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DOI：
10.1016/s0735-1097(02)01893-4
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发表时间：
2002-06-19
影响因子：
24
通讯作者：
Haines, DE
中科院分区：
文献类型：
--
作者：
Mangrum, JM;Mounsey, JP;Haines, DE
在肺静脉（PV）源房颤（AF）的患者中，我们寻求使用心内超声心动图（ICE）来评估PV解剖结构，指导射频（RF）消融并监测消融过程中的急性狭窄。然而，该过程可能是具有挑战性的，由于左心房和肺静脉的复杂解剖结构，不确定的导管定位内的肺静脉和困难米映射房性期外收缩，这可能是罕见的或反复诱导AF和需要cardioversion.METHODS六十四例患者被称为RF消融的AF的焦点源，和56被确定为具有AF触发大于或等于1 PV。在ICE引导下，在靠近开口的静脉周围施加射频损伤，直到有电隔离。（右上级肺静脉36例，左上级肺静脉33例，左下肺静脉9例，4例右下肺静脉）每根静脉需要24 +/- 12个病变才能建立电隔离，透视时间为11 +/- 4 min，平均22%管腔面积减少。经过13 +/- 7个月的随访，66%的患者仍然没有房颤，另外13%的患者对药物治疗反应更好。结论我们描述了一种解剖方法，PV电隔离，ICE用于定义解剖结构，引导射频消融和监测急性PV变化。
OBJECTIVES In patients with a pulmonary vein (PV) source for atrial fibrillation (AF), we sought the use of intracardiac echocardiography (ICE) to evaluate PV anatomy, guide radiofrequency (RF) ablation and monitor for acute stenosis during ablation.BACKGROUND A focal source for AF may be found in the proximal component of the PVs and can be effectively treated by ablative techniques. However, the procedure may be challenging due to the complex anatomy of the left atrium and PVs, uncertain catheter positioning within the PVs and difficulties m mapping atrial extrasystoles, which may be rare or repeatedly induce AF and require cardioversion.METHODS Sixty-four patients were referred for RF ablation of a focal source of AF, and 56 were identified as having AF triggers in greater than or equal to1 PV. Using ICE guidance, RF lesions were applied around the circumference of the vein near the os until there was electrical isolation.RESULTS Lesions were placed in 82 veins (36 right superior PV, 33 left Superior PV, 9 left inferior PV, 4 right inferior PV) 24 +/- 12 lesions per vein were necessary to create electrical isolation with a fluoroscopic time of 11 +/- 4 min and a mean of 22% reduction in luminal area. After a follow-up of 13 +/- 7 months, 66% of patients remained free of AF, and another 13% responded better to medications.CONCLUSIONS We describe an anatomic approach to PV electrical isolation in which ICE is used to define the anatomy, guide RF ablation and monitor for acute PV changes.