非右房入路二尖瓣置换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 non-right atrial approach to mitral valve replacement

作　　者：马薇[1] 卢凤民[1] 何乐[1] 张帆[1] 吴冬燕[1] 许静[1] MA Wei;LU Feng-ming;HE Le;ZHANG Fan;WU Dong-yan;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》2021年第2期149-153,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(2018XKC02)。

摘　　要：目的评价导管消融非右房入路二尖瓣置换术后房性心动过速(简称房速)的电解剖基质及射频消融。方法分析非右房入路二尖瓣置换术后房速消融病例,应用三维电解剖标测心房,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17例患者,其中间隔入路11例,左房入路6例。共诱发25种房速,其中间隔入路组诱发15种房速,大折返机制11例,局灶机制4例。左房入路组诱发10种房速。其中大折返机制6例。局灶机制4例。首次消融手术成功率94.1%(16/17)。平均随访(29±12)个月,有3例患者复发。手术成功率82.4%(14/17),2例进行二次消融后成功。结论非右房入路二尖瓣置换术后房速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 atrial tachycardias(ATs)after non-right atrial approach to mitral valve replacement.Methods Seventeen patients with ATs post non-right atrial approach to mitral valve replacement 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 25 mappable ATs included 11 interatrial groove approach and 6 left atrium approach.ATs in interatrial groove approach were macro-reentry ATs(11/15)and focal ATs(4/15),respectively.ATs in left atrium approach were macro-reentry ATs(6/10)and focal ATs(4/10),respectively.16/17(94.1%)patients were successfully terminated during procedure.After mean follow-up of(29±12)months,recurrences were observed in 3 patients after the first time catheter ablation.2 patients received second ablation and the achievement of freedom from arrhythmias reached 82.4%(14/17).Conclusion Catheter ablation of ATs post non-right atrial approach to mitral valve replacement is save and feasible.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(2):149-153]

关 键 词：心血管病学 瓣膜病 房性心动过速 射频消融 电解剖标测 

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