非接触心内膜激动标测系统指导房间隔缺损修补术后Ⅱ型心房扑动的射频消融(附一例报道)

评价非接触球囊导管标测系统 (EnSite 30 0 0 )在指导房间隔缺损 (ASD)修补术后心房扑动 (简称房扑 )的射频消融中的临床应用。 1例女性患者 ,41岁 ,ASD修补术后 2 2年开始频繁发作心动过速 ,体表心电图示Ⅱ型房扑。应用EnSite 30 0 0构建右房三维几何模型 ,标测心动过速的折返激动顺序 ,发现手术疤痕与三尖瓣环之间、下腔静脉与三尖瓣环之间为折返环路的关键峡部 ,应用导航系统指导峡部消融 ,成功阻断心动过速 ;消融后通过起搏标测判定峡部已达完全双向阻滞。随访 2 0个月 ,无心动过速复发。结论 :在ASD修补术后房扑的标测和消融中应用EnSite30 0 0系统是安全有效的 ,不仅能确定折返环路的关键峡部 ,而且能准确判断线性损伤的连续性。

Mapping and Ablation of Postoperative Atrial Flutter Using a Noncontact Mapping System.

The study evaluated a novel noncontact mapping system in guiding mapping and ablation of postoperative atrial flutter (AFL).A female patient,41 years old,suffered from reciprocating tachycardias after surgical repairment of atrial septal defect (ASD).Atypical AFL was suspected based on the surface electrocardiology.The noncontact balloon catheter was used to construct the geometry of right atrium and map the activation of tachycardia.The slow conduction zone between scar and tricuspid annulus and the isthmus between the tricuspid annulus inferior vena cava (IVC) were identified as the critical zone for tachycardia.The tachycardia was successfully ablated after a complete linear lesion of these two critical zones.The tachycardia was noninducible and the bi-directional block developed after ablation.No recurrence was observed during follow-up of 20 months.Conclusion:The study demonstrats that the use of noncontact mapping system is safe and effective for mapping and ablation of postoperative AFL.The system could not only precisely determine the critical zone for tachycardia,but also verify the linear continuity of the lesions.