术中峡部传导间期百分比对典型心房扑动导管消融终点判定的有效性评估  

Evaluation of trans-isthmus conduction time percentile in predicting complete bidirectional conduction block of typical atrial flutter

作　　者：王华 李博[1] 郝京霞[1] 张会敏 张涛[2] 张英谦[1] WANG Hua;LI Bo;HAO Jing-xia;ZHANG Hui-min;ZHANG Tao;ZHANG Ying-qian(Department of Pediatric Cardiology,Children’s Hospital of Hebei Province,Shijiazhuang 050000,China;不详)

机构地区：[1]河北省儿童医院心内科,河北石家庄050000 [2]首都医科大学附属北京安贞医院心内科

出　　处：《中国介入心脏病学杂志》2023年第12期911-914,共4页Chinese Journal of Interventional Cardiology

基　　金：河北省医学科学研究课题计划项目(20220774)。

摘　　要：目的通过术中测量三尖瓣-下腔静脉峡部(CTI)依赖心房扑动(房扑)消融前后峡部传导间期百分比,探讨峡部传导间期百分比在CTI线性阻滞消融终点评估的临床价值。方法本研究入组2021年2月至2023年2月诊断CTI依赖房扑并行射频消融治疗患者共37例(首都医科大学附属北京安贞医院35例,河北省儿童医院2例),术中均诱发CTI依赖房扑,并采用解剖消融方法沿三尖瓣环至下腔静脉行线性消融,术后经右心房激动标测验证CTI呈线性阻滞。分别统计入组患者心动过速周长(TCL)、冠状窦起搏下消融前局部传导间期(P-ABL1)、冠状窦起搏下消融后局部传导间期(P-ABL2),计算局部传导期间百分比(P-ABL2/TCL)。评估P-A BL 2/T C L对诊断C T I双向传导阻滞的价值,并通过消融后激动顺序验证其有效性。结果所有入组患者均采用解剖方法行射频消融,并行激动标测验证CT I呈线性阻滞。术中诱发TCL为(310.00±46.32)ms。术前测定P-ABL1为(92.16±27.65)ms,术后测量P-ABL2为(173.65±16.35)m s,两组数据差异有统计学意义(P<0.001)。术后P-A B L 2/T C L为(0.81±0.12)。P-A B L 2/T C L越接近1,评估C T I双向传导阻滞的特异性及有效性越高。结论采用术前局部传导间期可预估CTI阻滞终点,并结合术后P-ABL2/TCL的方法可提高CTI阻滞线完整性,减少反复消融,提高手术成功率。Objective The purpose of this study was to evaluate the predictive strength using the percentile of trans-isthmus conduction time during ablation of cavotricuspid isthmus(CTI)-independent typical atrial flutter for complete bidirectional conduction block.Methods This study was conducted with data from patients with typical atrial flutter(AF)who underwent ablation between February 2021 and February 2023(35 cases in the Beijing Anzhen Hospital,2 cases in the Children’s Hospital of Hebei Province).Atrial flutter was induced during the operation,and linear ablation along the tricuspid valve ring to inferior vena cava was performed by anatomic ablation.The data collected were baseline clinical characteristics,Tachycardia Cycle Length(TCL),local conduction interval under coronary sinus pacing before ablation(P-ABL1),local conduction interval under coronary sinus pacing after ablation(P-ABL2).The percentage of P-ABL2 to TCL after ablation was calculated to evaluate the value of post-ablation local conduction interval percentage in the diagnosis of AF ablation endpoint,and its effectiveness was verified by the post-ablation activation sequence.Results All enrolled patients underwent ablation,and CTI was linearly blocked by parallel activation marker test.The TCL was(310.00±46.32)ms.The P-ABL1 was(92.16±27.65)ms and the P-ABL2 was(173.65±16.35)ms.Results significant difference between the two groups(P<0.001).The percentage of P-ABL2 to TCL was(0.81±0.12).The percentage is close to 1,which is higher for evaluating the specificity and effectiveness of CTI bidirectional block.Conclusions The ablation endpoint of CTI block can be predicted by using the P-ABL1 before surgery,combined with the percentage of local conduction time after ablation.

关 键 词：心房扑动 局部传导间期百分比 射频消融 三尖瓣-下腔静脉峡部 双向传导阻滞 

分 类 号：R54[医药卫生—心血管疾病]