心脏外科术联合迷宫术后房性心律失常电解剖机制及射频消融  

Electroanatomic mapping and radiofrequency catheter ablation of atrial tachycardias after cardiac surgery and concomitant MAZE procedure

作　　者：马薇[1] 卢凤民[1] 何乐[1] 吴冬燕[1] 张帆[1] 樊少博[1] 许静[1] MA Wei;LU Feng-ming;HE Le;WU Dong-yan;ZHANG Fan;FAN Shao-bao;XU Jing(Tianjin Chest Hospital,Tianjin 30022,China)

机构地区：[1]天津市胸科医院心内科,天津300222

出　　处：《中国心脏起搏与心电生理杂志》2020年第6期555-559,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家青年科学基金(81900299);天津胸科医院院级课题(2018XKZ06)。

摘　　要：目的评价导管消融心脏外科联合迷宫术后复发房性心动过速(简称房速)的电解剖基质及射频消融。方法回顾性分析本院2016年1月至2019年1月心脏外科联合迷宫术后复发房速消融病例,所有房速应用三维标测于双房电解剖标测,结合拖带标测,明确房速机制后进行线性及基质消融。结果共入选27例,诱发出33种心动过速。右房起源房速7例,所有右房起源房速均与切口和/或三尖瓣环大折返相关;左房房速26例,大折返机制15例,微折返机制11例。首次消融手术成功率93.9%(31/33)。平均随访(31±18)个月,有5例患者复发。2例进行二次消融,总体手术成功率81.5%(22/27)。结论心脏外科联合迷宫术后房速患者行导管消融治疗安全、有效。Objective To analyze the electrophysiological mechanisms and the effect of radiofrquency catheter ablation of recurrent atrial tachycardias(ATs) after cardiac surgery and concomitant MAZE procedure. Methods Twenty-seven patients with ATs post Maze and concomitant open-heart surgery were included. According to high density precise mapping, activation mapping, voltage mapping and entrainment mapping, they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system. Results The 33 mappable ATs included 7 right atrium ATs and 26 left atrium ATs. All of the right atrium ATs were marco-reentrant around the tricuspid annulus and/or incision line. ATs in left atrium were macro-reentry ATs(15/26) and localized reentry ATs(11/26), respectively. 31/33(93.9%) ATs were successfully terminated during procedure. After mean follow-up of(31±18) months, recurrences were observed in 5 patients after the first time catheter ablation. 2 patients received second ablation and the achievement of freedom from arrhythmias reached 81.5%( 22/27). Conclusion Catheter ablation of ATs post Maze with concomitant surgery is save and feasible.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(6):555-559]

关 键 词：心血管病学 瓣膜病 先天性心脏病 外科迷宫术 房性心动过速 射频消融 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学]