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目的:探讨阵发性房颤患者环肺静脉电隔离术消融终点时诱发试验不同阴性结果预后差异。方法:回顾性选取133例因阵发性房颤接受消融且以诱发试验阴性(不能诱发或可诱发持续不超过3 min短阵房性心律失常)为消融终点、并成功达到终点的患者。所有患者均在环肺静脉电隔离后(定义为完成预设消融径线并达到肺静脉-左房双向电传导阻滞)行诱发试验,分别于冠状窦口及远端行猝发刺激(10 m A,脉宽2 ms),从300 ms递减直至心房失去1∶1夺获,如诱发持续>3 min短阵房性心律失常则进一步标测并进行局灶或折返环峡部消融。按照消融终点时诱发试验不同阴性结果分为不能诱发组(A组)和可诱发短阵(持续不超过3 min)房性心律失常组(B组)。空白期为3个月。患者术后定期随访心电图及Holter。结果:诱发终点情况:A组74例(55.6%),B组59例(44.4%)。术后平均随访(21.3±10.9)个月,首次消融术后复发45例(A组25例,B组20例)。KaplanMeier生存分析显示两组复发时间无显著差异(P=0.74)。结论 :对于采用环肺静脉电隔离术,以诱发试验阴性为消融终点的阵发性房颤患者,消融终点时不可诱发房性心律失常预后并不优于终点时可诱发短阵(<3 min)房性心律失常者。
OBJECTIVE: To investigate the prognostic difference of different negative results of induction test in patients with paroxysmal atrial fibrillation after pulmonary vein isolation. Methods: A total of 133 patients who had ablation termination due to paroxysmal atrial fibrillation (AF) and whose end-to-end ablation endpoints were negative (can not induce or induce short-term atrial arrhythmia lasting up to 3 minutes) were retrospectively selected. All patients underwent inducement test after electrical isolation of the pulmonary vein (defined as the completion of the preset ablation line and the pulmonary vein-left atrium bidirectional electrical conduction block), and burst stimulation at the coronary ostium and distal end respectively (10 m A, Pulse width 2 ms) from 300 ms until the atrial loss 1: 1 capture, such as short-term atrial arrhythmia induced by> 3 min was further mapping and focal or reentry ring isthmus ablation. According to different negative results of induction test at the end of ablation, the patients were divided into the induction group (group A) and the atrial arrhythmia group (group B) which could induce the short array (no more than 3 minutes). Blank period of 3 months. Patients were followed up regularly for electrocardiogram and Holter. Results: Induction end point: 74 cases (55.6%) in group A and 59 cases (44.4%) in group B. The patients were followed up for an average of 21.3 ± 10.9 months. After the first ablation, 45 cases relapsed (25 in group A and 20 in group B). KaplanMeier survival analysis showed no significant difference between the two groups (P = 0.74). CONCLUSIONS: Patients with paroxysmal atrial fibrillation using circumferential pulmonary vein isolation to induce negative end-to-end ablation should not induce atrial arrhythmia at the end of ablation and may not induce a shorter burst (<3 min ) Atrial arrhythmia.