房颤导管消融术后房速的发生机制与消融  

Mechanisms of Atrial Tachycardia After Catheter Ablation for Atrial Fibrillation and the Repeated Ablation

作　　者：林春艺[1] 黄卫斌[2] 陈超[2] 曾昭萍[2] 周法光[2] 郭晋村[2] 

机构地区：[1]福建医科大学附属漳州市医院,363000 [2]厦门大学附属中山医院厦门市心脏中心,361000

出　　处：《临床心电学杂志》2013年第4期262-265,共4页Journal of Clinical Electrocardiology

基　　金：厦门市科技局科研项目(编号:3502z20074003)

摘　　要：目的分析房颤射频消融术后房速与首次消融术式的关系,并观察再消融的效果。方法入选126例房颤患者,分为阵发性房颤PVI组、阵发性房颤CPVA组和持续性房颤组三组,对射频消融术后复发的房速再次行射频消融术,分析术后房速的发生机制,比较与首次消融术式的关系。结果 19例再消融患者经标测证实存在25种房速,其中17个(68%)为大折返机制,8个(32%)为局灶机制。多数房速(84%)与首次消融线的传导间隙(GAP)有关;所有房速患者经再次消融后,95%的房速经消融终止转为窦律;三组患者间术后房速的发生率无统计学差异。结论房颤射频消融术后房速的主要机制为折返机制,大多数折返环是依赖GAP所形成的,部分为局灶机制,房颤导管消融术后房速再次消融安全有效,成功率高。Objective To determine the mechanisms of atrial tachycardia （AT） after ablation of atrial fibrillation （AF）, and the relation between AT postablation and procedure of AF. Methods 126 patients were enrolled in this study, which divided into 3 groups ： PVI group, CPVA group and pe^istent group. The mechnisms of these ATs were determined through activation mapping by Carto XP 3-dimensional maps or entrainment mapping. These ATs and its initial AF ablation were compared to make clear their relations. Results A total of 25 ATs were mapped, and the mechamism was micro-re-entry in 17 （68%）, focal in 8（32%）. The critical isthmus in 16 （84%） traversed the prior ablation line , consistent with a gap-related mechanism. The majority was ablated successfully. Conclusions The mechanisms of ATs after CPVA are re-entrant, and nearly all of them are related to gaps in prior ablation lines. Repeat ablation may be effective and safety measure for ATs after catheter ablation.

关 键 词：心房颤动 房速 折返 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]