先天性心脏病术后下腔静脉口—三尖瓣环峡部依赖性心房扑动的导管消融疗效分析  

Catheter Ablation of Inferior-Vena Caval /Tricuspid Valve Isthmus Dependent Atrial Flutter in Patients With Surgically Corrected Heart Disease

作　　者：楚建民[1] 任振芳[1] 马坚[1] 姚焰[1] 方丕华[1] 华伟[1] 张澍[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心,北京市100037

出　　处：《中国循环杂志》2007年第1期28-30,共3页Chinese Circulation Journal

摘　　要：目的:报道先天性心脏病术后下腔静脉口-三尖瓣环峡部依赖性心房扑动的相对发生率及导管消融的疗效和安全性。方法:选择2002年1月-2006年4月在我院因先天性心脏病术后心房内折返性心动过速行射频消融的40例患者,应用常规电生理标测方法或三维标测方法(Carto和Ensite)指导导管消融,观察下腔静脉口-三尖瓣环峡部心房扑动相对发生率及其导管消融结果。结果:40例患者共诱发出50种房性心动过速,具有典型下腔静脉口-三尖瓣环峡部依赖性心房扑动心电图表现,且成功靶点在下腔静脉口和三尖瓣环峡部者31种(31／50,62．0％)。另外19种(19／50,38．0％)房性心动过速临床心电图表现与典型心房扑动不同,表现为P’波,其中11种(11／50,22．0％)成功靶点在右心房游离壁疤痕-下腔静脉峡部,瘢痕-上腔静脉峡部者2种,瘢痕与瘢痕之间峡部者2种;在瘢痕和三尖瓣环之间2种。房间隔补片和上腔静脉之间、房间隔补片和三尖瓣环之间各消融成功1种。40例患者射频消融成功,无并发症。随访1例患者心动过速复发,二次消融成功;1例患者出现持续性心房颤动伴RR长间歇,植入永久性起搏器。结论:先天性心脏病术后心房内折返性心动过速常常为下腔静脉口-三尖瓣环峡部心房扑动,导管消融具有较高的疗效和安全性。Objective：The purpose was to assess the incidence of inferior-vena caval/tricuspid valve （IVC-TA） isthmus dependent atrial flutter （IDAF） and the effectiveness and safety of catheter ablation tollowing heart disease surgery. Methods：Forty patients of atrial tachyarrhythmias after surgically corrected heart disease received catheter ablation in our hospital from January 2002 to April 2006. Thirty-four patients were ablated by guiding three dimensions mapping system （ Carto and Ensite 3000）and six patients were ablated by routine electrophysiological method. Results： Forty patients were induced 50 atrial tachycardias,31 episodes were typical atrial flutter electrocardiogram morphyology, and the successful ablation targets were involved in the isthmus between IVC-TA. Nineteen（ 19/50,38% ） IART with P＇ wave had successful ablation targets at the right free wall （Scar-IVC isthmus, Scar-SVC isthmus and Scar-Scar isthmus）. The slow conduction zone involved the region of the right atriotomy scar in 17/19 IART circuits and the atrial septal patch area in 2/ 19 IART circuits. Successful ablation was accomplished in all circuits and no procedural complications. Only one patient was seen recurrent IART after a mean follow-up of 27± 6 months. Conclusions ： IDAF is the most common mechanisms of atrial reentrant tachyarrhythmias in patients with surgically corrected congenital heart disease. The majority of circuits involve the inferior-vena caval/tricusoid valve isthmus.

关 键 词：心房扑动 心房内折返性心动过速 心脏外科手术 导管消融 

分 类 号：R541.4[医药卫生—心血管疾病]