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目的 总结 9例肺静脉相关的阵发性心房颤动 (PAF)合并其他类型快速心律失常的电生理特点和射频导管消融治疗的经验。方法 9例PAF患者 ,男性 6例 ,女性 3例 ,年龄 2 2～ 6 2(4 9 8± 12 5 )岁 ,PAF病史 3个月～ 10年。其中 3例合并预激综合征 ,2例成功阻断旁路传导 ,1例失败 ;2例合并房室结折返性心动过速 ,成功消融房室结慢径 ;3例合并的室性心律失常均起源于右心室流出道 ,2例导管消融成功 ,1例未消融 ;3例术前有典型心房扑动 (AFL)发作 ,行右心房峡部消融实现双向阻滞。经上述消融后 ,各病例仍有频繁PAF发作 ,电生理检查发现肺静脉异位冲动触发PAF发作。 8例进行了心脏大静脉电隔离 ,1例在电隔离后出现典型AFL发作 ,行右心房峡部消融成功。结果 随访 7～ 2 5个月 ,7例无PAF发作 ,2例仍有频发房性早搏和PAF发作 (包括未行肺静脉电隔离 1例 ) ,其他成功消融的室上性和室性心律失常无复发。结论 成功消融房室旁路、房室结慢径、右心房峡部、室性心律失常后不能消除或减少肺静脉相关的PAF发作 ,几种心律失常并存可以先后消融成功。肺静脉相关的PAF特点突出 ,旁路、双径路、典型AFL、室性心律失常的存在一般不会混淆其诊断的独立性
Objective To summarize the electrophysiological characteristics of 9 patients with pulmonary vein-associated paroxysmal atrial fibrillation (PAF) combined with other types of tachyarrhythmia and experience with radiofrequency catheter ablation. Methods Nine patients with PAF were enrolled in this study. There were 6 males and 3 females, ranging in age from 22 to 62 (498 ± 125) years. The history of PAF was from 3 months to 10 years. Three of them had Wolff-Parkinson-White syndrome, two of them successfully blocked the bypass, one failed. Two patients had atrioventricular nodal reentrant tachycardia and successfully ablated atrioventricular nodal slow pathway. Three patients with combined ventricular arrhythmia All of them originated in the right ventricular outflow tract, 2 cases of successful catheter ablation, 1 without ablation; 3 cases of typical atrial flutter before surgery (AFL) attack, right atrial isthmus ablation to achieve two-way block. After the above ablation, frequent episodes of PAF were still observed in all cases. Electrophysiological examination revealed that pulmonary vasoconsophageal anomalies triggered the onset of PAF. Eight patients underwent electrical isolation of the great cardiac vein, a typical AFL episode after galvanic isolation, and a successful ablation of the right atrial isthmus. Results The patients were followed up for 7 to 25 months. There were no PAF episodes in 7 patients, 2 patients had frequent atrial premature beats and PAF attacks (including 1 patient without pulmonary vein isolation), and other successful supraventricular and ventricular arrhythmias without ablation relapse. Conclusions Successful ablation of atrioventricular bypass, atrioventricular node slow pathway, right atrium isthmus and ventricular arrhythmia can not eliminate or reduce pulmonary venous-related PAF. Concurrent ablation of several cardiac arrhythmias can be succeeded. PAF characteristics associated with pulmonary veins are prominent, and the presence of bypass, dual-pathways, typical AFL, and ventricular arrhythmias generally do not confuse their diagnostic independence