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目的探讨不作肺静脉造影行阵发性心房颤动(房颤)环肺静脉电隔离术的有效性和可行性。方法 34例阵发性房颤患者分为无肺静脉造影组(n=18)和肺静脉造影组(n=16),无肺静脉造影组不作肺静脉造影,余步骤与肺静脉造影组相同,两组均在EnSiteNavX三维标测系统指导下重建左心房及肺静脉,再分别行左、右环肺静脉电隔离术,消融终点为肺静脉与心房完全电隔离。结果无肺静脉造影组消融术时间[(92.78±19.46)minvs.(106.44±20.18)min,P<0.05]及X-线曝光时间[(11.47±4.32)minvs.(16.06±8.72)min,P<0.05]少于肺静脉造影组,差异有统计学意义。两组左心房三维重建时间[(6.22±2.65)minvs.(6.31±3.00)min,P>0.05]、左、右侧环肺静脉消融时间[(21.61±7.66)minvs.(20.50±8.09)min,P>0.05;(17.33±10.22)minvs.(17.48±7.86)min,P>0.05]及即刻消融成功率[100%(18/18)vs.100%(16/16),P>0.05]比较,差异无统计学意义。结论不作肺静脉造影,仅在三维标测系统指导下行房颤消融治疗,可达到相同消融效果,可节省消融术及X-线曝光时间,减少手术步骤、耗材和费用。
Objective To investigate the feasibility and feasibility of circumferential pulmonary vein isolation without paroxysmal atrial fibrillation (AF) without pulmonary venography. Methods 34 patients with paroxysmal atrial fibrillation were divided into two groups: non-pulmonary venous angiography (n = 18) and pulmonary veno-angiography (n = 16), without pulmonary venography and pulmonary venography, EnSiteNavX three-dimensional mapping system under the guidance of reconstruction of the left atrium and pulmonary veins, respectively, left and right ring pulmonary vein electrical isolation, ablation end-to-end pulmonary vein and atrial electrical isolation. Results The time of ablation in the group without pulmonary vein angiography was (92.78 ± 19.46) min vs (106.44 ± 20.18) min, P <0.05, and the time of X-ray exposure was (11.47 ± 4.32) min vs (16.06 ± 8.72) min, P < 0.05] less than pulmonary vein angiography group, the difference was statistically significant. The time of three-dimensional reconstruction of the left atrium was (6.22 ± 2.65) min vs (6.31 ± 3.00) min, P> 0.05. The duration of pulmonary vein ablation in the left and right sides was (21.61 ± 7.66) min vs (20.50 ± 8.09) min, P> 0.05; (17.33 ± 10.22) minvs. (17.48 ± 7.86) min, P> 0.05] and the success rate of immediate ablation [100% (18/18) vs.100% (16/16), P> 0.05] ,The difference was not statistically significant. CONCLUSIONS: Pulmonary venography is not performed. Atrial fibrillation ablation can only be performed under the guidance of three-dimensional mapping system. The same ablation effect can be achieved. The ablation and X-ray exposure time can be saved, and the surgical procedures, consumables and costs can be reduced.