Carto标测指导导管消融心脏病术后心房内折返性心动过速  

Electroanatomical mapping and ablation of the substrate supporting intra-atrial reentrant tachycardia following heart disease surgery

作　　者：楚建民[1] 任振芳[1] 马坚[1] 方丕华[1] 华伟[1] 蒲介麟[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,北京100037

出　　处：《中华心律失常学杂志》2007年第3期174-177,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的：心脏外科术后的心房折返性心动过速（IART）折返环涉及无传导的或各向异性的传导障碍区，本研究的目的是利用三维电解剖标测系统（Carto）标测这些障碍区并确定与折返环的关系，指导导管消融。方法：22例患者共26种IART进行了Carto标测，首先确定形成IART的基质以及与折返环的关系，并在其峡部消融。结果：22例患者诱发出27种心动过速，对其中26种进行标测，12种IART中心障碍区为三尖瓣环，其消融靶点在下腔静脉一三尖瓣环峡部；12种IART中心障碍区在右心房游离壁，其消融靶点在其周围；2种IART中心障碍区在房间隔，并在此障碍区下方消融成功。即刻成功21例，其中峡部消融成功者12例、游离壁消融成功者7例、间隔部消融成功者2例。平均随访（22±7）个月，20例无心律失常发生而不需用药。结论：可以利用三维电解剖标测方法标测IART基质，这些基质构成IART的中心传导障碍区，消融靶点常常位于其周围。Objective The electrophysiologic mechanism of intra-atrial reentrant tachycardia（IART） is generally thought to be a macroreetrant circuit revolving around a nonconductive or highly anisotropic barrier. However,the electrical and anatomic substrate that supports these circuits has been incompletely defined. Our objectives were to characterize the atria of patients with IART and to determine these substrate associated with IART circuits by using Carto. Methods Twenty-six types of IART in 22 patients with a remote history of heart disease surgery were mapped with Carto and ablated by radiofrequency catheter ablation. Results In 26 types of IART circuits characterized, 12 types used the right AV valve as central obstacle, 12 types used a right freewall scar and 2 types circuits used an atrial septal scar. Success was achieved in 21 patients with 25 types of arrhythmias. The successful ablation target zone was at sites near free-wall scar in 7 patients, at site near septal scar in 2 patients, the typical atrial flutter isthmus was part of the circuit in 12 patient. At a mean duration of follow-up of （22±7 ） months ,20 patients were asymptomatic and did not require antiarrhythmia therapy. Con- clusion The substrate of IART can be identified in patient with heart disease surgery by electroanatomic mapping. These conduction barriers frequently functions as the central obstacle for IART.

关 键 词：心房折返性心动过速 三维电解剖标测 射频消融 

分 类 号：R65[医药卫生—外科学] R541[医药卫生—临床医学]