峡部双向传导时间对典型心房扑动导管消融终点判定的预测价值及探讨  

Evaluation of trans-isthmus conduction time in predicting complete bidirectional conduction block of typical atrial flutter

作　　者：林锦璇[1] 牛国栋[1] 冯天捷[1] 索妮 赵兰 张大炜[3] 鲁静朝[4] 马可忠[5] 王如兴[6] 欧阳繁 郑黎晖[1] 丁立刚[1] 姚焰[1] 张澍[1] Lin Jinxuan;Niu Guodong;Feng Tianjie;Suo Ni;Zhao Lan;Zhang Dawei;Lu Jingchao;Ma Kezhong;Wang Ruxing;Ouyang Fan;Zheng Lihui;Ding Ligang;Yao Yan;Zhang Shu(Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037 [2]山东省烟台市烟台山医院心内科 [3]北京中医医院心内科 [4]河北医科大学第二医院心内科 [5]湖北省襄阳市中心医院心内科 [6]江苏省无锡市人民医院心内科 [7]湖北省株洲市中心医院心内科

出　　处：《中华心律失常学杂志》2018年第3期209-214,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的在三尖瓣-下腔静脉峡部（CTI）依赖性心房扑动（房扑）患者中，采用三维系统指导下右心房高密度标测（HDM），评价线性消融后裂隙情况及CTI双向传导（TIC）时间≥130ms对CTI完全双向阻滞的预测价值。方法本研究为前瞻性、单臂、开放性的多中心临床研究，入选2014年12月至2016年7月7个中心连续39例CTI依赖性房扑患者，年龄（56．58±11．73）岁，男3l例。记录峡部线性消融后冠状静脉窦口与右心房低位游离壁双向传导时间，以及起搏时HDM所示右心房激动顺序是否为单一方向及消融线上有无裂隙各自的发生例数。计算峡部双向传导时间≥130ms对诊断峡部完全阻滞的灵敏度、特异度、阳性预测值及阴性预测值。结果23例CTI双向传导时间≥130ms的患者中有10例HDM存在裂隙，16例〈130ms的患者中有14例HDM出现裂隙。峡部传导时间≥130ms作为CTI完全性阻滞判断标准的灵敏度、特异度、阳性预测值及阴性预测值分别为86．67％、58．33％、56．52％、87．5％。24例存在传导裂隙患者中有14例裂隙部位为欧氏嵴侧，4例为三尖瓣环侧，1例为两侧均出现，5例未记录补点消融部位。结论峡部传导时间≥130ms不宜单独作为CTI完全双向传导阻滞的判断标准，右心房HDM可为更可靠的标准。消融后裂隙部位常见于欧氏嵴区域。Objective The purpose of this study was to evaluate the predictive strength using the criterion of trans-isthmus conduction （ TIC ） time of ≥ 130 ms post ablation of typical atrial flutter （ AFL ） for complete bidirectional conduction block, which was confirmed with high-density mapping （ HDM ） of right atrium. Methods This was a prospective, single-arm and open muhicenter study. The patients, aged （ 56.58 ± 11.73 ）years, 31 males, referring for cavotricuspid isthmus （ CTI ）-dependent AFL ablation were consecutively enrolled between December, 2014 and July, 2016. TIC intervals between the coronary sinus ostium （ CSO ） and low lateral right atrium （ LRA ） were recorded after ablation. Complete CTI block was determined by HDM of the right atrial activation. The sensitivity, specificity, positive and negative predictive values were calculated for the criterion of TIC time of ≥ 130 ms. Results After the initial CTI ablation, conduction gaps in the ablation line were found in 10 of the 23 patients with TIC time ≥ 130 ms and 14 of the 16 patients with TIC time 〈130 ms. The criterion of using bidirectional TIC time ≥ 130 ms predicted complete CTI block with 86.67% sensitivity and 58.33% specificity. The positive and negative predictive values were 56.52% and 87.5%, respectively. Of the 24 eases with conduction gaps post ablation, 14 were. found on Eustachian valve （ EV ）, 4 on the tricuspid valve end of the CTI, 1 on the both end and 5 were not available. Conclusions The study suggests that TIC time of ≥ 130 ms should not be used as a criterion for complete bidirectional conduction block of CTI after liner ablation and that HDM can be a more reliable criterion. The EV end of the CTI is the most common site for conduction gaps.

关 键 词：心房扑动 导管消融术 三尖瓣-下腔静脉峡部 高密度标测 

分 类 号：R541.75[医药卫生—心血管疾病]