新的兴趣窗设置识别心外科术后大折返性房性心动过速的舒张传导区作为消融靶点的研究--单中心经验  

Identifying the diastolic conduction zone as the ablation target by a novel window of interest for the macroreentrant atrial tachycardia after heart surgery——a single-centre experience

作　　者：黄深[1] 薛玉梅[2] 廖洪涛[2] 魏微 张文昶 李琪艳 何川[1] 吴书林[2] 丁春华 詹贤章[2] 

机构地区：[1]成都大学附属医院心内科,四川成都610081 [2]广东省心血管病研究所,广东省医学科学院,广东省人民医院心内科,广东广州510080 [3]北京大学航天中心医院心脏医学部,北京100049

出　　处：《中国心脏起搏与心电生理杂志》2017年第5期413-421,共9页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：广东省科技厅项目支持项目(No.2014A020221045)

摘　　要：目的心外科术后大折返性房性心动过速(MATs)的保护性峡部多数位于舒张期。设置新的兴趣窗(WOI)识别大折返环的舒张传导区(DCZ)指导MATs的消融。方法所有患者均在EnSite三维标测系统下进行高密度激动标测。MATs发作时根据P波顶点的位置计算WOI。WOI的起点位于折返环的舒张期,并通过激动图上白/紫相接部位识别DCZ。结果连续纳入心外科术后15例MATs的患者。一共完成了16种MATs[周长(259±56)ms]的标测。通过新的WOI设置识别16种MATs的DCZ[宽度(25.38±12.44)mm]均位于受保护的峡部。DCZ局部的传导速度明显慢于收缩期区域的传导速度[(38.9±13.68)cm/s vs(76.24±15.85)cm/s,P<0.05]。DCZ部位即刻消融成功率为100%。随访(11.5±5)个月,共有2例患者房性心律失常复发。结论通过新的WOI设置可以在电解剖标测图上根据白/紫相接的部位识别心外科术后MATs患者传导缓慢的DCZ部位。DCZ部位多数位于受保护的峡部,多数显示有碎裂电位。消融DCZ可以有效的终止心动过速。Objective The protective isthmus occurred during diastolic period in most macroreentrant atrial tachy- cardia （MAT） after heart surgery. We set a novel window of interest （WOI） to identify the diastolic conduction zone （DCZ） of the diastolic period to guide ablation of MAT. Methods The patients underwent high-density mapping using the EnSite NavX system. A novel WOI was calculated by identified the peak of the P wave of MATs, and the onset of the WOI was located inthe diastolic interval of the circuit. The DCZ was identified by white/violet inter- face. Results A total of 16 MATs （mean cycle length 259±56 ms） mapping were completed in 15 consecutive pa- tients after heart surgery. The DCZ （ mean width 25.38±12.44 mm） identified by the new setting of the WOI was located in all protective isthmus of the 16 MATs. Local conduction velocity at the sites of DCZ was significantly slower than the systolic area （38.9 ± 13.68 cm/s vs 76.24 ± 15.85 cm/s, P〈0.05）. The acute success rate was 100% with the DCZ ablation. During the （11.5± 5） months follow up, two patients had atrial tachyarrhythmia re- currence. Conclusions The DCZ of the MATs after heart surgery patients can be identified by the white / violet interface using a novel window of interest setting in electroanatomic mapping. Moreover, the DCZ is likely to locate in the protective isthmus, and exhibited with fractionated potentials and slow conduction velocitY. Ablation of DCZ can terminate the tachycardias effectively.

关 键 词：心血管病学 大折返性房性心动过速 电解剖标测 电生理 导管消融 外科手术 

分 类 号：R541.71[医药卫生—心血管疾病] R331.38[医药卫生—内科学]