慢性心房颤动消融术后房性心动过速的机制和消融治疗

目的 探讨慢性心房颤动(房颤)环肺静脉消融术后房性心动过速(房速)的机制及射频消融的方法.方法 慢性房颤消融术后房速患者9例,均为男性,年龄50～70(62.6±7.2)岁.在三维标测系统和环状标测导管联合指导下,对无心房-肺静脉电传导者的房速经标测在关键峡部消融;对存在心房一肺静脉电传导者的房速,在原消融径线上的裂隙处消融.结果 3例为无心房-肺静脉点传导的折返性房速,于关键峡部线性消融后房速终止;6例为存在心房-肺静脉电传导的房速,对原消融径线裂隙消融后,4例房速终止,余2例附加左心房峡部线性消融后房速亦终止.消融术时间为90～295(211.7±75.4)min,X线曝光时间为11.5～67.6(25.5±16.5)min.消融术后各种刺激亦均不能诱发房速,没有出现肺静脉狭窄和其他相关并发症.随访4～8(6.2±1.4)个月,9例患者停用抗心律失常药物后仍为窦性心律.结论 慢性房颤消融术后恢复心房-肺静脉电传导的房速(66.7%)占大多数;无心房-肺静脉电传导的房速多为折返机制;针对恢复传导部位的补点式消融和对折返环关键峡部的线性消融,可以成功终止并发的房速.

The treatment of recurrent atrial tachycardia originated from left atrium after continuous circular lesions around the ipsilateral pulmonary veins in patients with chronic atrial fibrillation

Objective To evaluate the radiofrequency(RF)ablation for the recurrent atrial tachycar-dia(AT)originated from left atrium(LA)after continuous circdar lesions(CCLs)around the ipsilateral pul-monary veins(PVs)in patients with chronic atrial fibrillation(AF).Methods A repeat procedure was per-formed in 9 patients[9 males;age 50～70(62.6±7.2)]with recurrent AT.In this procedure,LA-PV con-duction was confirmed by Lasso catheter.If no LV-PV conduction,activation mapping and entrainment tech-nique were performed with 3-D Carto system to identify the earliest activation area and reentrant cireuit. If LV-PV conduction recovered,the gap on the original CCLs was confirmed and was blocked again.Results No LA-PV conduction in the 3 patients and LA-PV conduction in 6 patients were demonstrated.In the 3 patients with-out LA-PV conduction,reentrant AT was confirmed and was successfuUy abolished by blocking the reentrant cir-cult.In the other 6 patients with LA-PV conduction,all conduction gaps were successfully closed with segmental RF ablation.Recurrent AT was successfully terminated in 4 patients and changed to macroreentrant AT in the other 2 patients.Following blocked the LA isthmus to terminate remained AT.The duration of the procedure was 90～295(211.7±75.4)min and the duration of X-ray was11.5～67.6(25.5 ±16.5)min.During follow-up of 4～8(6.2±1.4)months,all 9 patients were free of AT without antiarrhythmic drugs.Conclusions In pa-tients with recurrent AT after CCLs for chronic AF,AT without recovered LA-PV is complicated and can be abolished by mapping and ablation of reentrant circuit;AT with recovered LA-PV conduction(66.7%)is a dominant finding and can be successfully eliminated by segmental RF ablation.