Double multielectrode mapping catheters facilitate radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins
Double multielectrode mapping catheters facilitate radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins
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DOI：
10.1111/j.1540-8167.1999.tb00654.x
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发表时间：
1999-02-01
影响因子：
2.7
通讯作者：
Chang, MS
中科院分区：
文献类型：
--
作者：
Hsieh, MH;Chen, SA;Chang, MS
局灶性房颤的消融术简介：一些报告已经证明局灶性房颤（AF）可能起源于肺静脉（PV），本研究的目的是研究使用双多极标测导管消融局灶性房颤的安全性和有效性。方法和结果：42例阵发性房颤患者（男30例，女12例，年龄65 ± 14岁）接受导管消融术。在肺静脉造影引导下，将两个十极导管插入右上级肺静脉（RSPV）和左上级肺静脉（LSPV），或在必要时插入下肺静脉。所有患者均在基线期间（2例）、输注异丙肾上腺素（8例）或大剂量腺苷（2例）后、异丙肾上腺素下短阵快速起搏后（14例）或起搏诱发的AF复律后（16例）自发启动AF。房颤的触发点来自LSPV（12例患者）、RSPV（8例患者）和两个上级PV（19例患者）。肺静脉的触发点（共61个点）有18个（30%）位于肺静脉口，43个位于肺静脉内（9 - 40 mm）。在施加6 +/- 3次射频能量后，61个触发点中有57个完全消除，另外4个触发点部分消除。在8 +/- 2个月的随访期间，37例患者（88%）在未使用任何抗心律失常药物的情况下无症状性AF。20例患者接受了经食管超声心动图检查，19例显示小房间隔缺损（2.8 ± 1.2 mm）伴轻微分流。1个月后，15个缺损自发闭合。结论：使用双多电极标测导管的技术是标测和消融起源于肺静脉的局灶性房颤的一种相对安全、高效的方法。
Ablation of Focal AF. Introduction: Several reports have demonstrated that focal atrial fibrillation (AF) may arise from pulmonary veins (PVs), The purpose of this study was to investigate the safety and efficacy of using double multielectrode mapping catheters in ablation of focal AF.Methods and Results: Forty-two patients (30 men, 12 women, age 65 +/- 14 years) with frequent attacks of paroxysmal AF were referred for catheter ablation, After atrial transseptal procedure, two long sheaths were put into the left atrium. Two decapolar catheters were put into the right superior PV (RSPV) and left superior PV (LSPV), or inferior PVs if necessary, guided by pulmonary venography. All the patients had spontaneous initiation of AF either during baseline (2 patients), after isoproterenol infusion (8 patients) or high-dose adenosine (2 patients), after short duration burst pacing under isoproterenol (14 patients), or after cardioversion of pacing-induced AF (16 patients). The trigger points of AF were from the LSPV (12 patients), RSPV (8 patients), and both superior PVs (19 patients). The trigger points from PVs (total 61 points) were 18 (30%) in the ostium of PVs and 43 inside the PVs (9 to 40 mm), After 6 +/- 3 applications of radiofrequency energy, 57 of 61 triggers were completely eliminated, and the other 4 triggers were partially eliminated. During a follow-up period of 8 +/- 2 months, 37 patients (88%) were free of symptomatic AF without any antiarrhythmic drugs. Twenty patients received a transesophageal echocardiogram, and 19 showed small atrial septal defects (2.8 +/- 1.2 mm) with trivial shunt. Fifteen defects closed spontaneously 1 month later.Conclusion: The technique using double multielectrode mapping catheters is a relatively safe and highly effective method for mapping and ablation of focal AF originating from PVs.