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目的分析肺静脉前庭重构与环肺静脉前庭电隔离术(CPVI)后肺静脉-左房电传导恢复之间的关系。方法入选2007年1月至2009年9月因房颤行导管射频消融术后复发,再次消融患者359例(阵发性房颤180例,持续性房颤179例)。LASSO环状电极标测肺静脉-左房电传导恢复情况,在Carto系统引导下行补点消融。利用CARTO系统自带软件测量左右肺静脉前庭面积。结果 359例患者均顺利完成导管射频消融。阵发性房颤患者中有144例(80%)电传导恢复,其中单支肺静脉电传导恢复占45例(31.25%),2支占58例(40.28%),3支占24例(16.67%),4支恢复占17例(11.81%)。持续性房颤患者中有155例(86.59%)电传导恢复,其中单支肺静脉电传导恢复占24例(15.48%),2支占72例(46.45%),3支占17例(10.97%),4支占42例(27.1%)。阵发性房颤左肺静脉前庭面积(6.15±0.65)cm2,右肺静脉前庭面积(7.95±2.24)cm2。持续性房颤左肺静脉前庭面积(10.48±1.00)cm2,右肺静脉前庭面积(11.4±2.16)cm2。统计学分析提示阵发性房颤CPVI术后单支肺静脉电传导恢复比例高于持续性房颤(P=0.001),而持续性房颤4支肺静脉电传导恢复比例高于阵发性房颤(P=0.001)。阵发性房颤左、右肺静脉前庭面积均小于持续性房颤(P<0.001,P=0.022)。结论持续性房颤肺静脉前庭重构程度高于阵发性房颤,因此持续性房颤电隔离术后肺静脉-左房电传导恢复比例高于阵发性房颤。
Objective To analyze the relationship between pulmonary vestibular reconstruction and pulmonary vein-left atrial electrical conduction recovery after circumferential pulmonary veins vestibular electrical isolation (CPVI). Methods From January 2007 to September 2009, 359 patients (paroxysmal atrial fibrillation 180 cases, persistent atrial fibrillation 179 cases) were re-ablated because of atrial fibrillation recurrence after radiofrequency catheter ablation. LASSO ring electrode marked pulmonary venous-left atrial conduction recovery, guided by the Carto system down point ablation. Use CARTO system comes with software to measure left and right pulmonary vein vestibule area. Results All the 359 patients successfully completed catheter radiofrequency ablation. Among the patients with paroxysmal atrial fibrillation, 144 cases (80%) were electrically conductive, of which 45 cases (31.25%) were single pulmonary vein electrical conduction recovery, 58 cases (2 cases) and 24 cases (3 cases) %), 4 recovered in 17 cases (11.81%). Of the patients with persistent AF, 155 (86.59%) had electrical conduction recovery. Among them, 24 (15.48%) were single pulmonary vein electrical conduction recovery, 72 (46.45%) were 2, and 17 (10.97% ), 4 accounted for 42 cases (27.1%). Paroxysmal atrial fibrillation left pulmonary vein vestibular area (6.15 ± 0.65) cm2, right pulmonary vein vestibule area (7.95 ± 2.24) cm2. The left atrium vestibular area (10.48 ± 1.00) cm2 and the right pulmonary vein vestibular area (11.4 ± 2.16) cm2 in patients with persistent atrial fibrillation. Statistical analysis showed that the proportion of single pulmonary vein electrical conduction recovery after paroxysmal atrial fibrillation (CPVI) was higher than that of persistent atrial fibrillation (P = 0.001), while the recovery rate of persistent pulmonary venous conduction in 4 pulmonary AVs was higher than that of paroxysmal atrial fibrillation (P = 0.001). Paroxysmal atrial fibrillation left and right pulmonary vein vestibular area is less than persistent atrial fibrillation (P <0.001, P = 0.022). Conclusions The extent of vestibular remodeling of pulmonary veins in persistent atrial fibrillation is higher than that of paroxysmal atrial fibrillation. Therefore, the rate of pulmonary venous-left atrial electrical conduction recovery after persistent atrial fibrillation electrical isolation is higher than that of paroxysmal atrial fibrillation.