采用CARTO 3 Version 6.0系统指导心房颤动消融术后房性心动过速的标测和消融  

Using the novel CARTO 3 version 6.0 software for the mapping of atrial tachycardia in patients with prior atrial fibrillation ablation

作　　者：周公哺 白瑾[1] 李宗师 李蕾[1] 徐维 李延广 刘书旺[1] ZHOU Gong-bu;BAI Jing;LI Zong-shi;LI Lei;XU Wei;LI Yan-guang;LIU Shu-wang(Department of Cardiology,Peking University Third Hospital,NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Beijing 100191,China)

机构地区：[1]北京大学第三医院心内科,卫生部心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,北京100191

出　　处：《中国心脏起搏与心电生理杂志》2022年第4期325-329,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的采用CARTO 3 Version 6.0系统指导心房颤动(简称房颤)消融术后房性心动过速(简称房速)标测中的应用经验和技巧。方法2020年7月至2020年12月因房速行导管消融术的11例患者(以上患者均曾接受房颤导管消融术)。术中放置6F十极冠状静脉窦电极导管,在CARTO 3 Version 6.0系统指引下,利用PENTARAY高密度标测电极进行三维电解剖标测,在扩展的“早接晚”(EEML)功能中设置高阈值为75%~80%,对应的低阈值为25%~20%精准确认房速的关键部位及消融靶点,消融终止心动过速,验证消融线阻滞且心动过速不再自发及诱发则手术成功。结果11例术中均为房速心律,EEML能够提供清晰的瘢痕阻滞区,明确其房速机制,经标测后证实其中8例为单源性房速,余3例可经心房刺激诱发或自行转化出2种以上不同机制的房速。房速平均周长为(256.5±37.1)ms。肺静脉相关房速4例,其余包括顶部依赖折返2例、二尖瓣环折返1例,左房瘢痕相关折返性房速3例,右房瘢痕相关折返性房速1例。首次消融中所有患者房速终止并无法再次诱发。中位数随访时间8个月,1例房速复发并接受第二次消融,证实为顶部依赖折返,1例复发房颤。消融术中未出现严重并发症。结论CARTO 3 Version 6系统提供的EEML功能为识别瘢痕造成的阻滞区提供了更直观的手段。房颤消融术后房速的机制多样,通常与此前房颤消融造成的瘢痕有关。Objective To summarize the experiences in using the novel CARTO 3 Version 6.0 electroanatomic mapping system for the mapping of atrial tachycardias(AT)in patients with prior atrial fibrillation(AF)ablation.Methods Retrospectively,a total of 11 patients who underwent radiofrequency catheter ablation of AT between July 2020 and December 2020 were included.All patients had prior history of AF ablation.Coronary sinus catheter was places for each patient.With the assistance of CARTO 3 Version 6 electroanatomic mapping system,PENTARAY multipolar mapping catheter was used to identify the reentrant circle,critical isthmus and origin of ATs.Extented Early-meets-Late(EEML)module was used to assist the procedure.After terminating the tachycardia via ablation,complete block of ablation lines was confirmed without re-induction of tachycardia.Results Eight of 11 patients were identified with monomorphic AT and the rest 3 patients with 2 or more AT mechanisms.The average tachycardia cycle length was(256.5±37.1)ms.The most common AT mechanism was pulmonary vein related AT(4 cases),followed by left atrial scar-related reentrant AT(3 cases),roof dependent macro-reentrant AT(2 cases),mitral annulus macro-reentrant AT(1 case)and right atrial scar-related reentrant AT(1 case).Immediate success was achieved in all patients.During a median follow-up period of 8 months,1 patient underwent redo procedure for recurrent roof dependent macro-reentrant AT,and another patient experienced recurrence of AF,which was controlled by anti-arrhythmic drugs.No serious complication was documented in all procedures.Conclusion A diverse variety of AT mechanisms was observed in patients with prior AF ablation,most of which was related to substrate created by prior ablation.The Extented Early-meets-Late(EEML)module by CARTO 3Version 6system provides direct visualization of conduction block areas,which facilitates the interpretation of activation maps.

关 键 词：电生理学 房颤消融术后 房性心动过速 CARTO 3 Version 6.0系统 导管消融 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学]