CARTO标测指导射频消融治疗不适当的窦性心动过速

一例 34岁女性患者心悸、胸闷 2年半。Holter示最大心率 176次 /分 ,平均心率 12 7次 /分 ,固有心率 12 6次 /分。在基础窦性心律、静脉滴注 (简称静滴 )异丙肾上腺素后及射频消融术后分别行CARTO标测。静滴异丙肾上腺素后 ,心率从 14 5次 /分增至 170次 /分 ,最早激动点沿界嵴向上移动 3mm。消融靶点 (静滴异丙肾上腺素后的最早心房激动点 )由CARTO标测定位。在释放 2 1次射频电流进行射频消融后 ,未静滴异丙肾上腺素的心率从术前的14 5次 /分降至 98次 /分 ,静滴异丙肾上腺素后的心率从术前的 170次 /分降至 14 0次 /分。Ⅱ、Ⅲ、aVF导联上的P波形态从明显直立变为低平。术后第 3天Holter示最大心率和平均心率分别为 12 5次 /分和 95次 /分 ;固有心率为94次 /分。结论 :CARTO标测有助于精确地定位不适当的窦性心动过速的消融靶点 ,减少射频消融的放电次数 ,提高成功率。

Radiofrequency Catheter Ablation of Inappropriate Sinus Tachycardia Guided by CARTO Mapping

A 34-year-old female patient had had palpitation and chest distress for two and half years before admission for RFCA. Her maximal heart rate and mean heart rate were 176 and 127 bpm respectively on Holter recording pre-ablation. The intrinsic heart rate (IHR) was 126 bpm pre-ablation. CARTO mapping was made in baseline sinus rhythm,after infusion of isoproterenol and post-ablation. The heart rate was increased from 145 to 170 bpm and the earliest activation migrated 3 mm upwards along the crista terminalis after infusion of isoproterenol. The target sites which was the earliest atrial activation after infusion of isoproterenol,were determined and localized by CARTO mapping. The heart rate was decreased to 98 bpm without isoproterenol and to 140 bpm with same dosage of isoproterenol after 21 radiofrequency energy delivery on the earliest activation sites . The earliest activation migrated to the middle part of the right atrium downwards along the crista terminalis post-ablation and the morphology of P wave was changed from upright to flatten in Ⅱ,Ⅲ,aVF lead. The maximal heart rate and mean heart rate were decreased to 125 and 95 bpm respectively on Holter recording post-ablation . IHR was reduced to 94 bpm on third day after successful ablation. Conclusions: CARTO mapping could facilitate and ensure accurate targeting of specific anatomic sites of the earliest atrial activation during ablation of IST ,decrease the number of radiofrequency application,increase success rate.