目的  探讨磁导航指导下持续性心房颤动（房颤）导管消融患者术后复发的危险因素。方法  磁导航指导下，对49例持续性房颤患者行双侧肺静脉前庭电隔离+左心房顶部和二尖瓣峡部线性消融术。术后随访一年，分为房颤复发组（n=21）和房颤未复发组（n=28），比较两组患者手术操作时间、建模时间、肺静脉隔离时间、X线暴露时间、肺静脉前庭隔离急性成功率、手术相关并发症发生率及49例患者术后1个月、3个月、6个月和12个月的房颤复发率。结果  49例患者均成功实施左心房建模、标测和消融；复发组和未复发组手术操作时间、建模时间、肺静脉隔离时间、消融时间、X线暴露时间和肺静脉前庭隔离急性成功率差异均无统计学意义（P>0.05）。两组患者均未发生肺静脉狭窄、心脏穿孔、心包填塞和猝死等严重并发症。随访一年，持续性房颤消融成功率为57.1%;Cox回归分析提示术前房颤发作时间及合并冠心病与术后房颤复发有关。 结论  磁导航指导下持续性房颤导管消融具有较高的有效性和较好的安全性。术前房颤持续时间及合并冠心病是术后持续性房颤复发的独立危险因素。

ObjectiveTo investigate the recurrence factors in patients with persistent atrial fibrillation(PAF) after catheter ablation guided by magnetic navigation system. MethodsBilateral pulmonary vein antrum isolation(PVAI) plus linear ablation at left atrial(LA) roof and mitral isthmus were performed in 49 PAF patients using magnetic navigation system. After oneyear followup, 49 patients were divided into AF recurrence group(21 cases) and AF nonrecurrence group(28 cases). We separately compared the procedure time, duration of LA modelling, duration of PVAI, Xray exposure time, acute success rate of PVAI,incidences of procedurerelated complications, and AF recurrence rates at 1 month, 3 months, 6 months and 12 months respectively between the two groups. ResultsLA modelling, mapping and ablation were successfully performed in 49 cases. Between the two groups, the procedure time, modelling time, duration of PVAI, abaltion duration, Xray exposure time and acute success rate of PVAI did not vary significantly(P>0.05). No serious complications such as pulmonary vein stenosis, cardiac perforation, pericardial tamponade and sudden death occurred in either of the two groups. The success rate of PAF ablation was 57.1% during 1 year of followup. Cox regression analysis indicated that the lasting time of preoperative AF and coronary heart disease were associated with postoperative AF recurrence. ConclusionThe efficacy and safety of PAF ablation are pretty good using magnetic navigation system. The lasting time of preoperative AF and coronary heart disease are independent risk factors of postoperative AF recurrence.