三维标测系统指导下多环心房扑动的射频消融治疗  

Treatment of multiring atrial flutter by radiofrequency catheter ablation guided with 3 dimensional mapping system

作　　者：王洪[1] 洪浪[1] 赖珩莉[1] 陈再华[1] 邱贇[1] 欧阳长生[1] 周元凤[1] 

机构地区：[1]江西省人民医院心内二科,江西南昌330006

出　　处：《中国心脏起搏与心电生理杂志》2011年第5期401-405,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨三维标测系统指导下多环心房扑动(AFL)的射频消融疗效。方法 4例AFL患者,在三维标测系统(CARTO或EnSite Array)指导下建立相应心房三维模型并进行激动标测及电压标测,并对折返的关键峡部作线性消融。结果 4例患者均显示出多个折返环,其中1例标测出右房3个折返环、左房1个折返环,分别围绕上腔静脉、三尖瓣环、下腔静脉及左房房顶共4种折返环;其余3例患者每例均标测出2种折返环,分别为环绕上腔静脉与三尖瓣环的8字折返、环绕下腔静脉与三尖瓣环的8字折返及环绕上腔静脉、环绕右心耳的折返环。4例消融均获成功。其中1例AFL终止后窦性静止,提示病窦综合征,术后1周安置永久起搏器。随访2～9个月,无复发。结论多环AFL的心房内折返错综复杂,应用三维标测系统可清楚地显示折返途径及关键峡部。Objective To investigate the efficacy of radiofrequency catheter ablation （RFC） guided by 3 dimensional mapping system （3DMS） on treatment of multirment of atrial flutter（AFL）. Methods For 4 patients with AFL, atrial three dimensional model, activation and voltage mapping as well as linear ablation at the the critical isthmus in reentrant circuit were applied under the guidence of 3DMS （Carto or EnSite Array Mapping System）. Results All cases were discovered having multiple reentrant circuits, among which,one case was mapped with three kinds of reentrant circuits in fight atrium and one reentrant circuit in left atrium, arotmding superior vena cave, tricuspid anulus, inferior vena cave ,and the roof of left atrium respectively. Two kinds of reentrant ciruits were mapped in other 3 cases,which included 2 of the following 4 reentrant circuits, 8 font style reentrant circuit arounded superior vena cave and tricuspid anulus, 8 font style reentrant circuit arounded inferior vena cave and tricuspid anulus,reentrant circuit arounded right auricle. All of the four cases were treated succeessfully. Sinus arrest appeared in one case after terminated AFL,and sick sinus syndrome was diagnosed. Permanent pacemaker was implanted after one week of RFCA. No one reccurred at a follow up survey for 2 -9 months after RFCA. Conclutions Intra atrial reentry of multiple circuits AFL is highly complicated. Reentrant pathways and critical isthmus can be showed clearly under application of 3DMS.

关 键 词：电生理学 三维标测系统 心房扑动 折返环路 导管消融 射频电流 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]