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目的比较持续性心房颤动(房颤)导管消融术后复发二尖瓣峡部心房扑动(房扑)患者不同消融策略,探讨复发二尖瓣峡部相关房扑的优化消融方案。方法回顾性分析2010年1月至2012年12月北京安贞医院持续性房颤导管消融后复发,术中电生理检查明确为二尖瓣峡部相关房扑的患者74例。根据再次消融时不同消融策略分为两组:心动过速下消融组(A组,43例)和复律后窦性心律下消融组(B组,31例)。消融终点均为双侧肺静脉电隔离以及左心房顶部线、二尖瓣峡部线、三尖瓣峡部线的双向传导阻滞。术后随访比较两组患者未服用抗心律失常药物情况下窦性心律的维持率。结果两组患者年龄、性别、体重指数、高血压病、糖尿病、冠心病等比较,差异均无统计学意义(均P>0.05)。两组患者二尖瓣峡部阻断、肺静脉、左心房顶部线及三尖瓣峡部消融线比较,差异均无统计学意义(均P>0.05);B组患者手术时间[(132.5±29.6)min比(150.2±41.1)min,P=0.044]、透视时间[(23.1±8.6)min比(27.9±7.2)min,P=0.011]和消融时间[(14.0±4.1)min比(16.3±4.7)min,P=0.027]显著低于A组,差异均有统计学意义。平均随访(16.9±6.3)个月,两组患者窦性心律维持率比较,差异无统计学意义(P=0.771)。结论持续性房颤初次导管消融术后复发二尖瓣峡部相关房扑的患者,复律后窦性心律下消融与心动过速下消融相比更为简化,长期随访窦性心律维持率无显著差异。
Objective To compare different ablation strategies in patients with atrial flutter of mitral isthmus after atrial fibrillation with catheter ablation of persistent atrial fibrillation (AF) and to explore the optimal ablation protocol of atrial isthmus associated with recurrent mitral isthmus. Methods Retrospective analysis of recurrence of persistent AF after catheter ablation in Anzhen Hospital of Beijing from January 2010 to December 2012 was performed. Electrophysiological examination was performed in 74 patients with mitral valve isthmus associated with atrial flutter. According to the ablation strategy, the ablation strategy was divided into two groups: tachycardia ablation group (group A, n = 43) and cardioversion sinus rhythm ablation group (n = 31). End-point ablation were bilateral pulmonary vein electrical isolation and left atrial top line, mitral valve isthmus, tricuspid isthmus line bidirectional conduction block. Postoperative follow-up compared two groups of patients without taking anti-arrhythmic drugs, the maintenance of sinus rhythm. Results There was no significant difference in age, sex, body mass index, hypertension, diabetes mellitus and coronary heart disease between the two groups (all P> 0.05). There was no significant difference in mitral valve isthmus, pulmonary vein, left atrium top line and tricuspid isthmus between the two groups (all P> 0.05). The operative time in group B was (132.5 ± 29.6) min (14.3 ± 4.1) min and (16.3 ± 4.7) min after fluoroscopy were significantly higher than those of the control group (150.2 ± 41.1 min, P = 0.044) min, P = 0.027] were significantly lower than the A group, the differences were statistically significant. The mean follow-up was (16.9 ± 6.3) months. There was no significant difference in sinus rhythm maintenance between the two groups (P = 0.771). Conclusions In patients with persistent atrial fibrillation recurrence of mitral valve isthmus after primary catheter ablation, sinus rhythm ablation during cardioversion is more simplified than ablation under tachycardia, and there is no significant difference in long-term follow-up of sinus rhythm maintenance difference.