运用超高密度标测系统对Marshall束介导的左房大折返房扑的标测及消融  

Mapping and Ablation of Left Atrial Reentrant Atrial Flutter Mediated by Marshall Bundle Using Ultra-high-density Mapping System

作　　者：刘颖[1] 杨文杰 李希 张劲林[1] 陈艳红[1] 邓成钢[1] Liu Ying;Yang Wenjie;Li Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院心内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2022年第3期395-400,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：武汉市卫生健康委员会医学科研项目(No.WX20C44)。

摘　　要：目的 运用超高密度标测方法(Rhythmia系统)探索Marshall束参与的左房大折返性房扑的电生理特点和消融策略。方法 选取于武汉亚洲心脏病医院心内科行房颤导管消融或心脏外科术后持续性房扑的患者,射频消融术中运用Rhythmia系统对房扑进行激动标测。对激动标测诊断为Marshall束参与的左房大折返性房扑的电生理特点和消融结局进行分析。结果 共纳入138例房颤消融或外科术后房扑患者,共标测198种房扑,其中7例诊断为Marshall束参与的左房大折返性房扑。7例房扑均通过超高密度标测发现左肺静脉及左心耳之间出现激动跳跃(颜色断层现象,提示房扑由Marshall束介导),心内膜类局灶样激动点提示Marshall束插入点。术中首先消融Marshall束在心内膜的插入点,如无效则行Marshall静脉无水乙醇消融。7例患者均可于术中终止心动过速,术中即时成功率100%。围手术期无消融并发症,术后常规随访(12±9)个月,无复发病例。结论 超高密度标测可以高效、准确地诊断心外膜Marshall束介导的心房扑动,并可以找到Marshall束的心内膜插入点。对这类房颤的标测和消融策略取得了满意的临床结果。Objective To explore the electrophysiological characteristics and ablation strategies of left atrium macro-reentrant atrial flutter(AF)medicated by Marhshall bundle using the ultra-high-density mapping system.Methods Patients with post-surgery or post-ablation macro-reentrant AF were included in this study.All patients were mapped with ultra-high-density mapping system(Rhythmia system),and Marhshall bundle-mediated macro-reentrant AF patients were screened out.Their electrophysiological characteristics and ablation outcomes were analyzed.Results Among the 138 patients/198 types of AFs included, 7 cases were diagnosed with left atrial macro-reentrant AF mediated by the Marshall bundle branch.Ultra-high-density mapping system was effective in identifying the direct excitement jump(colour tomography phenomenon)between the left pulmonary vein and the left atrial appendage in all 7 cases.The ultra-high-density mapping system could also detect the endocardial insertion point of the Marshall bundle(manifested as a pseudo-focal excitement pattern of endocardium).Catheter ablation of the Marshall endocardial insertion point was conducted to terminate AF.If the catheter ablation failed, ethanol ablation of Marshall vein was then performed.AF was terminated in all 7 cases during the operations, indicating the success rate was 100%.There were no complications reported during the perioperative period.During a median follow-up period of(12±9)months, all patients remained relapse-free.Conclusion Ultra-high-density mapping can efficiently and accurately diagnose a specific type of AF mediated by the epicardial Marshall bundle.It is also effective in finding the endocardial insertion point of Marshall bundle.The mapping and ablation strategy of AF has achieved satisfactory clinical outcomes.

关 键 词：超高密度标测 导管消融 房扑 Marshall束 无水乙醇消融 

分 类 号：R541.7[医药卫生—心血管疾病]