心外膜大折返性房性心动过速的高密度标测及消融  

High density mapping and ablation of epicardial macro-reentrant atrial tachycardia

作　　者：郭琦 赖一炜 高明阳 郭雪原[1] 戴雯莉[1] 蒋超[1] 李松南[1] 刘念[1] 刘晓霞 黄丽洪 左嵩[1] 李昌义 赵欣[1] 蒋晨曦[1] 汤日波[1] 龙德勇[1] 桑才华[1] 董建增[1] 马长生[1] Guo Qi;Lai Yiwei;Gao Mingyang;Guo Xueyuan;Dai Wenli;Jiang Chao;Li Songnan;Liu Nian;Liu Xiaoxia;Huang Lihong;Zuo Song;Li Changyi;Zhao Xin;Jiang Chenxi;Tang Ribo;Long Deyong;Sang Caihua;Dong Jianzeng;Ma Changsheng(Center of Arrhythmia,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Centre for Cardiovascular Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心律失常中心、国家心血管疾病临床医学研究中心,北京100029

出　　处：《中华心律失常学杂志》2023年第6期513-519,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨高密度标测在复杂心外膜大折返性房性心动过速(MRAT)标测中的作用, 阐明心外膜MRAT的电生理及消融特点。方法本研究为回顾性描述性研究。纳入2019年10月至2022年6月于北京安贞医院心律失常中心进行射频消融治疗的心房颤动(房颤)术后复发心外膜MRAT患者, 应用高密度标测及拖带标测对MRAT进行标测及消融, 总结不同心外膜结构参与的MRAT的电生理及消融特点。结果共纳入心外膜MRAT患者61例, 其中男41例, 年龄(61.0±10.3)岁。45例(73.8%, 45/61)为Marshall韧带(LOM)介导的二尖瓣峡部依赖性心房扑动(PMAT)。PMAT是最常见的心外膜MRAT类型, 其次为双心房折返MRAT 9例, 隔肺束相关顶部依赖MRAT 7例。LOM介导的PMAT的心动过速周长为(260.0±39.7)ms, 心内膜面标测的周长为(207.1±42.5)ms, 标测周长缺失4%~32%, 其中34例患者为逆钟向PMAT, 11例患者为顺钟向PMAT。隔肺束相关顶部依赖MRAT心动过速周长为(257.4±42.5)ms, 心内膜面标测的周长为(172.6±40.0)ms, 标测周长缺失10%~61%, 其中3例患者在右前斜下表现为逆钟向MRAT, 4例患者为顺钟向MRAT。双心房折返MRAT心动过速周长为(254.0±39.6)ms, 心内膜面标测的周长为(228.8±48.8)ms, 标测周长缺失2%~35%, 其中5例患者为LOM及Bachmman束参与的双心房折返, 2例患者为隔肺束、Bachmman束及卵圆窝参与的双心房折返, 2例患者为冠状静脉窦与Bachmman束参与的双心房折返。随访(16.5±4.4)个月, 7例患者复发房性心律失常。结论心外膜MRAT多见于房颤广泛消融后, 高密度标测有助于发现心外膜传导, 拖带标测可进一步证实。Objective To investigate the role of high density mapping in complex epicardial macro-reentrant atrial tachycardia(MRAT),and to clarify the electrophysiological and ablation characteristics of MRAT.Methods This study was a retrospective descriptive research.The patients with recurred epicardial MRAT after the ablation of atrial fibrillation(AF)from October 2019 to June 2022 in the Center of Arrhythmia Beijing Anzhen Hospital were continuous included.The mechanism of MRAT were diagnosed and clarified Using high density mapping and entrainment mapping,and the electrophysiological and ablation characteristics in different types of epicardial MRAT were summarized.Results A total of 61 patients with epicardial MRAT 41 males,mean age(61.0±10.3)years were enrolled.Forty-five cases with ligament of Marshall(LOM)related perimitral artial tachycardia(PMAT),9 cases with biatrial MRAT,and 7 cases with roof-dependent MRAT mediated by septal pulmonary bundle.The tachycardia circle length(TCL)of LOM-mediated PMAT was(260.0±39.7)ms,the mapping circle length was(207.1±42.5)ms,representing a range of 4%to 32%of the TCL not recorded from left atrium(LA)endocardium.Thirty-four patients had counter clockwise PMAT and 11 patients had clockwise PMAT.The TCL of septal pulmonary bundle related roof dependent tachycardia was(257.4±42.5)ms,the mapping circle length was(172.6±40.0)ms,representing a range of 10%-61%of the TCL not recorded from LA endocardium.Three patients showed counter clockwise MRAT at right anterior oblique,and 4 patients showed clockwise MRAT.The TCL of biatrial MRAT was(254.0±39.6)ms,the mapping circle length was(228.8±48.8)ms,representing a range of 2%-35%of the TCL not recorded from LA endocardium.Among which 5 patients had biatrial MRAT involving LOM and Bachmman bundle,2 patients had biatrial MRAT involving the septal pulmonary bundle,Bachmman bundle and fossa ovale,and 2 patients had biatrial MRAT involving coronary sinus(CS)and Bachmman bundle.After follow-up of(16.5±4.4)months,7 cases(11.5%)of patients r

关 键 词：心房颤动 大折返性房性心动过速 心外膜传导 高密度标测 导管消融 

分 类 号：R541.71[医药卫生—心血管疾病]