二尖瓣置换联合心房颤动迷宫术后房性心动过速的电生理特点与射频消融疗效  

The electrophysiological characteristics and radiofrequency ablation of atrial tachycardia after mitral valve surgery combined with atrial fibrillation Maze procedure

作　　者：沈文志 张静梅 刘宇 陈诤 白剑[1] 蓝荣芳[1] 徐伟[1] Shen Wenzhi;Zhang Jingmei;Liu Yu;Chen Zheng;Bai Jian;Lan Rongfang;Xu Wei(Department of Cardiology,Nanjing Drum Tower Hospital,THe Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Cardiology,Yizheng Hospital,Nanjing Drum Tower Hospital Group,Nanjing 211900,China)

机构地区：[1]南京大学医学院附属鼓楼医院心内科,210008 [2]南京鼓楼医院集团仪征医院心内科,211900

出　　处：《中华心律失常学杂志》2021年第6期515-519,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的回顾性分析二尖瓣置换联合心房颤动(房颤)迷宫术后房性心动过速(房速)的电生理特点和射频消融预后。方法入选2018年8月至2020年8月在南京鼓楼医院心内科接受射频消融治疗二尖瓣置换联合房颤迷宫术后房速患者25例,其中男9例,女16例,年龄(56.5±10.4)岁。采用Carto三维标测系统,在房速下行右心房和左心房高密度三维电解剖标测。基于激动标测和电压标测图揭示其房速机制,从而指导房速消融和预防性的基质改良消融。结果34种房速被标测与分析(26例次自发、8例次诱发)。33例次(97.1%,33/34)为折返机制,心动过速周长(256±43)ms,1例次为局灶机制。20(58.8%,20/34)例次房速起源于左心房。20例次(60.6%,20/33)房速为解剖大折返,6例次为二尖瓣环折返。33例次折返房速中,22例次(66.7%,22/33)单纯高密度激动标测明确折返径路,10例次需拖带标测明确折返径路。手术中23例患者消融转复为窦性心律(92.0%,23/25),2例电复律转复为窦性心律。随访(15±6)个月,76.0%(19/25)患者无复发,6例复发患者中3例(50.0%,3/6)接受再次消融并成功。结论高密度三维电解剖标测能更准确显示复杂瘢痕房速机制和基质,指导其成功消融。基质改良消融可能进一步减少房速复发。Objective To investigate the electrophysiological characteristics of postoperative atrial tachycardia(AT)in patient with prior mitral valve surgery combined with surgical atrial fibrillation(Maze)ablation and the radiofrequency ablation.Methods From August 2018 to August 2020,twenty-five patients with mitral valve surgery and Maze procedure undergoing AT ablation in Department of Cardiology,Nanjing Drum Tower Hospital,were enrolled.There were 9 males and 16 females,aged(56.5±10.4)years.Right and left atrium were mapped during AT by high-density electroanatomic mapping.The mechanism of AT was revealed based on activation and voltage mapping,thereby guiding AT ablation and substrate modifications.Results A total of 25 patients had 34 kinds of AT were mapped and analyzed(26 spontaneous and 8 induced).Of the 34 kinds of AT,33(97.1%,33/34)were reentrant mechanism,with 20(58.8%,20/34)originated from left atrium.Among 33 AT,20(60.6%,20/33)were anatomic macroreentrant AT,with 6 perimitral AT.Only one case was focal mechanism.Twenty-two(66.7%,22/33)AT were diagnosed by high-density activation mapping alone,the rest needed entrainment maneuver.During the operation,23 patients were converted to sinus rhythm by ablation(92.0%,23/25).Two patients were converted to sinus rhythm by electrical cardioversion.Freedom from AT was followed up for(15±6)months,76.0%(19/25)of the patients had no recurrence.Of the six patients with recurrence,3(50.0%,3/6)patients with recurrence underwent re ablation and succeeded.Conclusion High-density three-dimensional electroanatomic mapping can accurately reveal the mechanism and the substrate of complex scar-mediated AT and guide its successful ablation.The substrate modification may further reduce the recurrence of AT.

关 键 词：心房颤动 房性心动过速 高密度标测 射频消融 心脏外科 

分 类 号：R654.2[医药卫生—外科学]