二尖瓣外科术后与房间隔切口相关的双房折返性房性心动过速的电生理特征及消融策略  

Electrophysiological characteristics and ablation strategy of biatrial reentrant atrial tachycardia associated with atrial septal incision after mitral valve surgery

作　　者：黄尾平 张劲林[1] 韩宏伟[1] 程光辉[1] 邓成钢[1] 张勇华[1] 苏晞[1] HUANG Wei-ping;ZHANG Jin-lin;HAN Hong-wei;CHENG Guang-hui;DENG Cheng-gang;ZHANG Yong-hua;SU Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,Hubei,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2021年第5期429-433,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：第七批武汉中青年医学骨干人才工程项目。

摘　　要：目的评估二尖瓣术后与房间隔切口相关的双房折返性房性心动过速(简称房速)的标测和消融策略。方法入选84例武汉亚洲心脏病医院曾行二尖瓣外科术后的房速患者,应用超高密度标测系统对其左右房进行激动标测,发现10例双房折返房速,同时分别于左右房折返径路的多个部位进行拖带标测。结果通过分析左右房三维激动标测图,将双房折返房速分为三种不同的类型。在其所有类型中,后下心房间的连接为双房折返房速的关键连接束,其分别与其他心房间连接(Bachmann束、卵圆窝和冠状静脉窦口)共同完成心动过速的双房折返。大部分房速(8/10)于后下心房间连接的左房或右房的激动突破部位消融终止心动过速。结论通过超高密度标测可明确房间隔切口相关的二尖瓣术后的双房折返性房速的折返径路,后下心房间连接为折返环路的重要组成部分,应成为消融的首选靶点。Objective To assess the mapping and ablation strategy of this special category of atrial tachycardia(AT). Methods We identified 10 biatrial tachycardia(BiATs) in a total of 84 ATs after mitral valve surgery performed at three institutions. Activation maps both for the right atrium(RA) and left atrium(LA) were obtained with the use of an ultra high density mapping system. We also performed entrainment pacing from multiple LA and RA site within the speculative circuit. Results By analyzing activation and propagation maps of both atria, we classified the circuit into three distinct types. In all types, posteroinferior interatrial connections act as a critical limb which combined with other interatrial connections(the Bachmann′s bundle, fossa ovalis and coronary sinus ostium in three types respectively) to complete the circuit of BiATs. Most ATs(6/7) were terminated targeting the RA and LA end of posteroinferior interatrial connection sites. Conclusion Ultrahigh density mapping provides a detailed description of the macroreentrant circuit of BiAT associated with interatrial septal incisions. Posteroinferior interatrial connections was essential for the circuit and should be the preferential target for ablation.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(5):429-433]

关 键 词：电生理学 房性心动过速 射频消融 超高密度标测 折返性心动过速 房间隔 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]