运用超高密度标测方法行二尖瓣瓣膜置换术后持续性房性心律失常的标测及消融  

Mapping and ablation of persistent atrial arrhythmia after mitral valve replacement using ultrahigh resolution mapping

作　　者：李希 张劲林[1] 陈艳红[1] 赵安全 LI Xi;ZHANG Jin-lin;CHEN Yan-hong;ZHAO An-quan(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435000

出　　处：《中国心脏起搏与心电生理杂志》2022年第1期33-37,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：湖北省卫生计生科研基金全新团队资助(WJ2018H0043)。

摘　　要：目的运用Rhythmia系统对二尖瓣瓣膜置换术后持续性房性心律失常进行超高密度激动标测及消融。方法连续入选2016年11月至2018年12月二尖瓣置换瓣术后出现持续性房性心律失常患者。术中心房扑动(简称房扑)发作时运用Rhythmia系统网篮电极标测导管进行激动标测(左房和/或右房),确定并消融房扑折返关键峡部或局灶房性心动过速最早激动区域。结果共入选43例患者中,男性22例,年龄(55±9)岁,共标测出持续性房性心律失常数量为50种,标测时间(13.1±4.2)min,其中三尖瓣峡部相关房扑13例,二尖瓣峡部房扑10例,肺静脉gap相关房扑11例,房间隔切口相关房扑9例,右房游离壁切口1例,左房疤痕相关3例,右房疤痕相关1例,局灶房性心动过速2例。单一心律失常患者28例。围手术期无消融相关并发症,随访(23±11)个月。术中即时成功率100%,术后总成功率88%,5例患者复发,均再次行射频消融(心律失常机制与首次消融心律失常机制不同),术中均成功终止心动过速。结论运用超高密度标测能够快速准确地对复杂持续性房性心律失常进行标测及消融,并有较高的成功率。Objective We used the Rhythmia system to map and ablate persistent atrial arrhythmia after mitral valve replacement. Method Forty-three consecutive patients with persistent atrial arrhythmias after mitral valve replacement from November 2016 to December 2018 were enrolled.The age of these patients was(55±9)years,22 males and 21 females.Activation mapping(left and/or right atria)was performed using the Rhythmia system basket electrode mapping catheter during the onset of atrial arrhythmias to identify and ablate the area where the critical isthmus was or the earliest activation of focal atrial tachycardia. Result Among the 43 patients,the number of atrial flutter was 50,and the mapping time was(13.1±4.2)minutes,including 13 tricuspid isthmus-related atrial flutter,10 mitral isthmus-related atrial flutter,11 pulmonary vein gap-related atrial flutter,9 atrial septal incisionrelated atrial flutter,1 right atrial free wall incision,3 left atrial scar-related,1 right atrial scar-related,and 2 focal atrial flutter.There were 28 patients with single atrial flutter and 15 patients with two or more types.There were no ablation-related complications during the perioperative period,and the follow-up period was(23±11)months.The success rate was 100%in time during operation.The total success rate was 88%.Five patients had recurrence after operation and underwent radiofrequency ablation again.The mechanism of recurrent arrhythmia was different from that of original arrhythmia,and the ablation was successful. Conclusion Complex atrial arrhythmias can be mapped and ablated by the ultra-high resolution mapping with a high success rate.[Chinese Journal of Cardiac Pacing and Electrophysiology,2022,36(1):33-37]

关 键 词：心血管病学 超高密度标测 导管消融 心房扑动 心脏瓣膜病 外科迷宫术 房性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病] R542.51[医药卫生—内科学]