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目的 总结和分析采用脉冲电场消融（PFA）实施肺静脉前庭电隔离结合肌袖消融（PVAI+SA）治疗阵发性心房颤动（简称房颤）的有效性和安全性。方法 回顾性纳入2025年3月至2025年10月于本中心行PFA治疗的阵发性房颤患者。所有患者均在三维电解剖标测系统指引下应用压力感应PFA导管进行肺静脉前庭电隔离，再应用环形PFA导管进行肺静脉肌袖消融。手术终点为：(1)左心房-肺静脉传导阻滞；(2)环形PFA导管消融范围覆盖肺静脉肌袖；(3)肺静脉内自主电活动完全消失。记录患者一般临床资料及术中数据，术后对患者进行症状及心电图随访。结果 总计纳入58例患者，平均年龄（65.6±9.4）岁，其中男性36例（62.1%）。术中18.2%的肺静脉在隔离后可见自主电活动，首次消融中所有患者均达到预设的消融终点，平均左心房操作时间为（38.6±7.1） min。术后中位随访时间277(233,319) d,30 d空白期后，54例（93.1%）患者未出现房性心律失常复发。围手术期及随访期间未出现心包积液、心房食管瘘、冠状动脉损伤、膈神经麻痹、肾功能下降、肺静脉缩窄等并发症。结论 采用PFA进行PVAI+SA的新术式治疗阵发性房颤具备良好的安全性和有效性。
Abstract：Objective To summarize and analyze the efficacy and safety of a novel pulsed field ablation(PFA) procedure—pulmonary vein antrum isolation combined with sleeve ablation(PVAI+SA)—for the treatment of paroxysmal atrial fibrillation(AF). Methods Patients with paroxysmal AF who underwent PFA at our center between March 2025 and October 2025 were retrospectively consecutively enrolled. A contact force-sensing PFA catheter was used for pulmonary vein antrum isolation(PVAI), followed by a circular multipolar PFA catheter for pulmonary vein(PV) sleeve ablation. The procedural endpoints were: complete PVAI; circular PFA ablation fully covering all PV myocardial sleeves; elimination of spontaneous PV electrical activity. Recorded the patients general clinical information and intraoperative data. Regular postoperative follow-up was applied for all patients. Results A total of 58 patients were enrolled, with a mean age of(65.6±9.4)years, including 36 males(62.1%). Spontaneous electric activity after isolation was observed in 18.2% of all pulmonary veins. All patients achieved the predefined endpoints in the initial procedure. Mean left atrial procedural time was(38.6±7.1) min. During a median follow-up of 277(IQR: 233, 319) days, 54 patients(93.1%) remained free from recurrent atrial arrhythmias after a blanking period of 30 days. No major complications including pericardial effusion, atrial-esophageal fistula, coronary artery injury, phrenic nerve palsy, renal function decline, or pulmonary vein stenosis, were observed. Conclusion The novel PFA strategy of PV sleeve ablation added to conventional PVAI demonstrates favorable safety and efficacy profiles for the treatment of paroxysmal AF.
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基本信息:
DOI：10.13333/j.cnki.cjcpe.XXXX.XX.001
中图分类号:R541.75
引用信息:
[1]周公哺,李宗师,段俊滔,等.脉冲电场消融治疗阵发性心房颤动：肺静脉隔离结合肌袖消融[J].中国心脏起搏与心电生理杂志().DOI:10.13333/j.cnki.cjcpe.XXXX.XX.001.
基金信息:
国家自然科学基金(31700674)
2026-09-20
2026-09-20
2026-09-20