单中心球囊冷冻消融术后房性快速性心律失常的电生理标测和再消融治疗  

Electrophysiological mapping of recurrent atrial tachyarrhythmias after pulmonary veins cryoballoon radiofrequency ablation and the outcomes of re-ablation therapy

作　　者：唐恺[1] 肖彬 黄小红[3] 赵冬冬[1] 郭荣[1] 李海玲[1] 徐亚伟[1] TANG Kai;XIAO Bin;HUANG Xiaohong;ZHAO Dongdong;GUO Rong;LI Hailing;XU Yawei(Department of Cardiology,Shanghai Tenth People's Hospital,School of Medicine,Tongji University,Shanghai 200072,China;Jiande Hospital of Integrated Traditional Chinese and Western Medicine,Jiande 311612,Zhejiang Province,China;Department of Orthopaedics,Shanghai Tenth People's Hospital,School of Medicine,Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院心内科,上海200072 [2]建德市中西医结合医院,浙江建德311612 [3]同济大学附属第十人民医院骨科,上海200072

出　　处：《同济大学学报（医学版）》2022年第1期31-36,共6页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金(81700291)。

摘　　要：目的对阵发性心房颤动(简称房颤)患者行球囊冷冻消融后复发房性快速性心律失常的电生理机制进行初步探讨。方法连续入选阵发性房颤行球囊冷冻消融后复发房性快速性心律失常、并行再次消融的患者。术中使用三维电解剖标测系统,先对左心房进行电压标测,判断各支肺静脉及肺静脉前庭是否仍有电传导,若有,则行射频消融,完成肺静脉及肺静脉前庭的电隔离。之后,在患者自发或诱发心律失常条件下,寻找肺静脉以外的病灶。对于稳定性心律失常,消融其局部病灶或关键峡部;若为持续房颤,则消融左心房后顶部线及后底部线,尽量实现消融线的双向阻滞。结果共有43例患者入选,男性28例(65.1%),平均年龄(65.9±11.8)岁。43例患者共175支肺静脉,其中6例患者(14.0%)共计12支肺静脉(6.9%)仍有电传导。27例(62.8%)患者虽肺静脉内已实现电隔离,但肺静脉前联合或后联合处的前庭部位仍有电传导,具体表现:左侧前联合21例,左侧后联合18例,右侧前联合25例,右侧后联合17例。10例患者有非肺静脉病灶,其中5例位于右心房,5例位于左心房。结论肺静脉前庭的前、后联合部位仍存在电传导,是球囊冷冻消融术后复发房性快速性心律失常最常见的电生理现象。Objective To investigate the electrophysiological mechanisms of recurrent atrial tachyarrhythmias after pulmonary veins(PVs)cryoballoon ablation.Methods Patients with recurrent atrial tachyarrhythmias after PVs cryoballoon radiofrequency ablation who were recommended for re-ablation procedure,were enrolled in the study.The voltage mapping was performed in the left atrium to distinguish and ablate those PVs/PV antrum regions with electrical connection,by using CARTO 3 system.Then non-PVs drivers of atrial fibrillation(AF)were identified,and the triggers or critical isthmus would be ablated.While the roof line and the bottom line connecting both sides of PVs would be ablated in patients with sustained AF.Results Among 43 enrolled patients there were 28 males with a mean age of(65.9±11.8)years.The atria and all the 175 PVs were mapped.Electrical connection was seen in 12 PVs(6.9%)of 6 patients(14.0%).While electrical connection was more commonly(n=27)found in PVs antrum between the superior PV and the inferior PV,namely the anterior PV junction or the posterior PV junction,including the left anterior PV junction in 21 cases,the left posterior PV junction in 18 cases,the right anterior PV junction in 25 cases,and the right posterior PV junction in 17 cases.Non-PVs drivers of atrial fibrillation were identified only in 10 cases.Conclusion Electrical connection in PVs/PV antrum might be the underlying mechanism of recurrent atrial tachyarrhythmias after pulmonary veins(PVs)cryoballoon ablation.

关 键 词：心房颤动 球囊冷冻消融 复发 电生理标测 

分 类 号：R541.75[医药卫生—心血管疾病]