中文摘要：

目的：探讨在远程磁导航系统（ RMN）辅助下应用加强消融策略行心房纤颤（ AF）射频消融治疗对AF远期成功率的影响。方法连续选取2013年1月至2015年6月在解放军总医院住院行导管射频消融治疗且自愿参加该临床研究的患者49例非瓣膜性AF患者随机分成两组，传统消融组（CAG， n＝24）和加强消融组（EAG， n＝25）。 CAG组对左右肺静脉行单环线性消融，EAG组在CAG消融基础上，靠近原有消融径线，在心房侧再次行线性消融，形成双环线性消融。术中应用磁导航消融导管，RMN系统、CARTO 3系统和Lasso环状标测电极，术后常规使用24 h动态心电图随访。结果所有患者均消融成功，EAG组较CAG组消融时间明显延长[（45.66±6.59）vs （40.10±3.48）min，P＜0．01]，而在曝光时间、手术时间和静脉血测定脑利钠肽前体上差异无统计学意义（ P＞0．05）。术后随访（19.3±5.6）个月，应用动态心电图随访发现EAG组复发率较CAG组明显降低（33.33％vs 8.00％，P＜0．05）。二次手术时发现复发患者均存在电传导恢复情况，8例再次手术均成功。结论加强消融策略能有效改善AF患者的远期成功率，降低复发率。

英文摘要：

Objective To assess the long-term efficacy of enhanced ablation in pulmonary vein antrum （ PVA） guided by remote magnetic navigation （ RMN） in the patients with atrial fibrillation （ AF） .Methods From January 2013 to June 2015, 49 consecutive patients with refractory non-valvular AF who undergoing radiofrequency catheter ablation and voluntarily taking part in this study in our hospital were recruited in this study .They were randomized into a conventional ablation group （ CAG, n =24 ） and an enhanced ablation group （ EAG, n=25） .PVA isolation was achieved by creating a single ablation circle in the patients of CAG group , and was double ablation circles at PVA in those of EAG group .An irrigated magnetic ablation catheter , CARTO 3 mapping system and Niobe magnetic navigation were used in both groups .A Lasso？ mapping catheter was used to confirm PVA isolation.Regular Holter monitoring was used to follow up all patients .Results PVA isolation succeeded in all the patients .Ablation energy delivery time was obviously longer in EAG group than in CAG group [（45.66 ±6.59） vs （40.10 ±3.48） min, P〈0.01].There were no significant differences in fluoroscopic time , procedure time and venous NT-proBNP level between the 2 groups （ P〉0.05） .During the follow-up of （19.3 ±5.6） months, Holter monitoring showed that the AF recurrence rate was remarkably lower in EAG group than in CAG group （8.00%vs 33.33%, P〈0.05）.Reconnection between left atrium and PV was confirmed in 8 relapsed patients during re-ablation, and reoperation was successful in all of them .Conclusion Enhanced PVA ablation effectively improves the long-term outcomes of AF and reduces the recurrence rate .