CARTO标测指导大折返性房性心动过速导管消融的临床疗效分析

目的 探讨三维标测系统指导下大折返性房性心动过速(macroreentry atrial tachycardia,MAT)电生理特征和消融效果.方法 2009年8月至2011年9月本科电生理检查确诊的MAT共计38例,年龄(48.4±10.8)岁,男性17例,女性21例,38例中15例为持续性或无休止性心动过速.合并右房明显扩大12例.常规电生理检查初步确定房速的起源心腔,在CARTO三维标测系统指导下行三维电激动和／或电压标测,确定MAT关键峡部及其基质,用冷盐水灌注导管行相应的线性消融或局灶性消融.结果 ①右房MAT共31例,27例无外科手术及消融术病史,54.8％( 17/31)为单个折返环MAT,45.2％( 14/31)合并其他类型心动过速.31例MAT均行三尖瓣峡部消融,30例消融峡部房扑终止.16例单纯消融峡部达到消融终点,另14例则同时行其他部位消融.②7例左房MAT均为导管消融术后患者,其中4例在原有的消融线上存在传导裂隙(GAP),3例为二尖瓣峡部依赖性房扑.6例消融成功.③本组消融成功率为94.7％ (36/38).随访时间2～36(18.6±4.5)个月,7例复发[复发率19.4％ (7/36)],5例再次消融成功,随访期间89.5％ (34/38)的患者无房速发作.结论 右房MAT常与三尖瓣峡部和自发性瘢痕有关,而左房MAT多与手术损伤有关,三维标测有助于提高复杂心律失常的消融成功率.

Clinical efficiency of CARTO-guided catheter ablation in treatment of macroreentry atrial tachycardia: report of 38 cases

Objective To explore the clinical value of the electroanatomical CARTO three-dimensional mapping system guiding in assessment of electrophysiological features of macroreentry atrial tachycardia(MAT) and in the efficiency of radiofrequency ablation.Methods Clinical data of 38 MAT patients who received the above therapy in our hospital from August 2009 to September 2011 were collected.There were 17 males and 21 females at the age of(48.4±10.8),15 patients has persistent/or permanent tachycardia,and 12 patients had right atrial enlargement among the 31 patients with MAT from right atrium.No surgery or catheter ablation was present in 27 patients.In the 31 patients,54.8%(17of 31)had single reentrant cycle and 45.2%(14 of 31)were complicated by other tachycardia in those cases.Conventional electrophysiological study was performed to determine the location of MAT before the three-dimensional electroanatomic mapping.Using voltage and activation maps guided by CARTO mapping system,the mechanism of tachycardia was analyzed and the slow conduction areas(critical isthmus) were verified.Radiofrequency energy was delivered using irrigated-tip catheter.Results The cavotricuspid isthmus was ablated in all those 31 patients with MAT from right atrium,and the termination of atrial flutter was obtained in 30 cases.The successful ablation termination point was obtained in 16 patients with single reentrant cycle after only isthmus ablation,but ablation of other sites was simultaneously performed in other 14 cases.All of 7 patients with MAT from left atrium were post-ablation,the central conduction obstacle(GAP) was existed at the previous ablation line in 4 cases and at the mitral isthmus in 3 cases,and the successful ablation was obtained in 6 patients.The successfully-ablated rate was 94.7% in this study(36/38) at discharge.During the follow-up of(18.6±4.5) months,7 patients were recurred,in which 5 patients were successfully re-ablated.Therefore,tachy-arrhythmia free rate was 89.5 %(34/38) during the follow-up.Conclusion MAT form right atrium is often related to cavotricuspid isthmus and sponaneous scarring,but MAT from left atrium is usually related to surgery or ablation.CARTO three-dimensional electroanatomic mapping system is helpful for an effective ablation in complicated tachycardia.