先天性心脏病外科修补术后三尖瓣峡部依赖型心房扑动手术瘢痕区消融的必要性  

Necessity of ablating SCAR with tricuspid isthmus-dependent atrial flutter in congenital heart disease after surgical repaired

作　　者：李世杰[1,2] 韩冰[2] 李为东[2] 蒋树中 李先进[2] 盛燕辉[1] 孔祥清[1] 

机构地区：[1]南京医科大学附属第一临床医学院心内科,210029 [2]东南大学附属徐州市中心医院心内科,江苏省221009

出　　处：《中华临床医师杂志（电子版）》2015年第16期22-24,共3页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨先天性心脏病外科修补术后三尖瓣峡部依赖型心房扑动，手术瘢痕区消融的必要性，是否存在形成心动过速的折返基质，评价消融的疗效。方法2010年1月至2013年12月共入选48例在徐州市中心医院心脏科行经右心房游离壁切口治疗先天性心脏病后发作心房扑动的患者，其中单纯三尖瓣峡部依赖型心房扑动为3l例，在这3l例患者三尖瓣峡部双向阻滞后，在窦律下行右心房基质标测，确定瘢痕区域并局部高密度标测。在冠状窦近端刺激下，标测瘢痕是否存在“Channel”和缓慢传导区，有局部形成折返基质，来决定是否消融瘢痕区至腔静脉。结果11例标测过程中低电压区内可标测到1～5（2．6±1．2）个双电位线（LDPs）和（或）电静止区（ESAs），且大多数LDPs和ESAs在房性心动过速终止后的窦性心律下仍可见到。在此区域内可记录到低幅、长时限碎裂电位，平均振幅（0．21±0．05）mV，平均时限（123±14）ms，占心动过速周长（43±5）％。窦律下起搏冠状窦近端提示瘢痕线未形成传导阻滞，存在潜在形成折返基质，消融瘢痕至腔静脉。20例提示瘢痕已形成解剖屏障，未消融瘢痕区域。随访（36±12）个月，2例患者复发，均为心房颤动合并左心房心房扑动。结论经右心房切口术后三尖瓣峡部依赖型心房扑动，在三尖瓣峡部双向阻滞后，有必要在窦律下行右心房基质标测和起搏标测，评价瘢痕能否会形成潜在心动过速通道，减少不必要的消融。Objective The purpose of this study was to explore the necessity of ablating SCAR with tricuspid isthmus-dependent atrial flutter in congenital heart disease after surgical repaired, and evaluate the effect of ablation. Methods Forty-eight consecutive patients with AT after an incision of the right ata-ial free wall to the treatment of congenital heart disease were colleced. 31 AFLs were merely CTI-depended AFL and were all treated with CTI ablation successfully, in sinus rhythm, the mapping of substrates in the right atrial, and local high density mapping in SCAR was determined. Under the coronary sinus proximal stimulation, mapping the existence of scar ＇channel＇ and slow conduction zone, there was potential for forming the tachycardia subslrates, determine whether ablation sear to vena eava. Results In 11 patients, the reentry circuits were located within a large low voltage （bipolar votage≤0.5 mV） area in different parts of right atrium, which contained, electrically silent areas （ESAs） and/or line of double potentials （LDPs）. In the isthmus of the circuits, low amplitude （0.21±0.05）mV, long duration （123±14）ms fractionated electrogram were fotmd, which accounting for （43±5）% of the TCL. 11 cases were ablated thescar from the vena to cava. 20 cases indicated that the scar had formed the anatomic barrier, had no ablated. All of the eases were followed up about （36＋12）months, 2 patients recurred, and were complicated with left atrial atrial fibrillation and atrial flutter. Conclusion Tricuspid isthmus dependent atrial flutter was in congenital heart disease after surgical repair. After the tricuspid isthmus was blocked, it is necessary about the mapping of substrates in the fight atrial, and local high density mapping in SCAR was determined, to assess potential taehveardia of the SCAR. and reduce unnecessary ablation.

关 键 词：心脏缺损 先天性 心房扑动 手术修补 射频消融 

分 类 号：R654.2[医药卫生—外科学]