Carto标测指导下射频导管消融左心耳房性心动过速

目的探讨三维电解剖Carto指导下标测消融源于左心耳部位房性心动过速(房速)的方法和可行性。方法结合电生理和空间信息,首先利用Carto系统建立左心房三维解剖结构。对3例起源于左心耳的房速进行Carto标测,根据Carto标测来确定最早激动点,并以此为靶点进行射频消融。同时分析心动过速时体表心电图的P波特点。结果电解剖标测证实3例房速均为局灶性房速,其最早激动点起源于左心耳,并向左心房前壁、房间隔和后下壁激动。左心耳放电成功消融3例房速。体表心电图分析显示房速时Ⅱ、Ⅲ、aVF和V1导联P波为正向,I、aVL导联为完全负向。结论三维电解剖标测可以清楚显示左心耳解剖结构以及源于其中的房速的激动顺序并有利于经导管进行射频消融。

Electroanatomical mapping and catheter ablation of atrial tachycardia originated from left atrial append-age

Objective The aim of this study was to evaluate the use of the electroanatomical mapping system, in 3 consecutive patients with atrial tachycardia originated from left atrial appendage. Methods Electroanatomical mapping of left atrial activation was performed in 3 patients with sustained atrial tachycardia. The earliest local activation was identified by Carto mapping as a target site for radiofrequency catheter ablation. Surface 12-lead ECGs were documented in all patients during atrial tachycardia. Results The three-dimensional mapping allowed a rapid demonstration of focal mechanism and visualization of the earliest action wavefront originated from the left atrial appendage, which propagated along left atrial anterior wall, septum to posterior wall. Catheter ablation by targeting arrhythmogenic focus eliminated 3 atrial tachycardia in left atrial appendage. Analysis of surface P wave configuration showed positive P wave in lead II , III, aVF and V1, and negative P wave in lead I and aVL. Conclusions Visualization of atrial activation in a three-dimensional reconstruction of the left atria and left atrial appendage using electroanatomical mapping system facilitates understanding of the mechanism and improves the anatomically guided catheter ablation of left atrial tachycardia originated from left atrial appendage.