超高密度标测下非手术疤痕相关的右房房性心动过速的消融  

Ablation strategy for non-postsurgical scar-related right atrial tachycardia under ultra-high-density mapping

作　　者：陈耽 郭再雄[1] 张劲林[1] 李康[2] 李希 赵安权 丁燕生 苏晞[1] CHEN Dan;GUOZai-xiong;ZHANG Jin-lin;LI Kang;LI Xi;ZHAO An-quan;DIN Yan-sheng;SU Xi(Department of Cardiology,Wuhan Asia Heart Hospital,Wuhan 430022,Hubei,China;Department of Cardiology,Peking University First Hospital,Beijing 100034,China;Boston Scientific Corporation,Shanghai 200023,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022 [2]北京大学第一医院心内科,北京100034 [3]波科国际医疗贸易(上海)有限公司,上海200023

出　　处：《中国心脏起搏与心电生理杂志》2023年第3期203-209,共7页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的总结非手术疤痕相关的右房房性心动过速(简称房速)在超高密度标测下的电生理特点及消融经验.方法回顾分析武汉亚洲心脏病医院及北京大学第一医院两所机构中使用Rhythmia超高密度标测系统进行右房房速导管消融治疗的134例患者,选择既往无心脏手术史的非手术瘢痕相关右房房速患者作为研究对象.通过超高密度标测系统研究其电生理折返机制.结果18例患者入选,其中13例为持续性房速,5例为阵发性房速.在手术过程中,共观察到52种不同的房速,平均每例患者(3.2±1.5)个房速,心动过速周长为(264.7±32.5)ms.大多数患者在标测或消融过程中,房速很容易转化为具有不同心动过速周长和P波形态的另一种房速.最终,完成45个房速的标测图.分析这些激动标测图,发现非手术疤痕相关的右房房速可分为6型.致密疤痕的不同位置和延伸与房速的折返机制有关.结论使用超高密度标测系统能显示非手术瘢痕相关右房房速的折返环路,并提供了相应的消融策略.Objective To summarize the electrophysiological mechanism and ablation strategy of non-postsurgical scar-related right atrial tachycardia(AT)by using an ultra-high-density mapping system.Methods A retrospective analysis was made of 134 patients who underwent catheter ablation of right atrium(RA)AT with the Rhythmia mapping system at two institutions.Patients with spontaneous RA scarring and no prior atrial surgery were included in this study.We sought to investigate the mechanism of electrophysiological reentry of these right AT by using an ultra-high-density mapping system.Results Eighteen patients were enrolled including thirteen persistent ATs and five paroxysmal ATs included in the study.During the procedure,a total of 52 different ATs[mean(3.2±1.5)ATs per patient].The mean tachycardia cycle length was(264.7±32.5)ms.In most patients,ATs easily converted into a different AT with a different tachycardia cycle length and P-wave morphology during mapping or ablation.Ultimately,we complete activation maps for 45 ATs.By analyzing activation maps,we classified atrial tachycardias into six categories.The discrepant location and extension of electrically silent areas were associated with different AT mechanisms.Conclusions The detailed activation patterns of complex non-postsurgical scar-related ATs could be demonstrated by using the ultra-high-density mapping system,and provide the corresponding ablation strategy.[Chinese Journal of Cardiac Pacing and Electrophysiology,2023,37(3):203-209]

关 键 词：心血管病学 房性心动过速 导管消融 三维标测 超高密度标测 

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