多极导管粗标消融导管经Swartz鞘细标的方法消融右心房房性心动过速

目的　探讨右心房房性心动过速的导管标测和消融方法。方法　常规电生理检查确诊 12例右心房房性心动过速后 ,2 0极标测导管在右心房内弯曲、旋转粗标右心房的不同面 ,寻找较体表心电图 P波提前的相对较早的心房内心电图 ,以此心电图的电极对作为参考点 ,消融导管通过 Swartz鞘在该点附近仔细标测 ,寻找最早心房激动点消融。射频消融的能量从 15 W开始逐渐递增至 2 5 W。结果　 12例右心房房性心动过速均消融成功 ,无并发症 ,随访 (2 6± 14 )月未见复发。成功消融部位在冠状窦口附近 5例 ,希氏束附近 2例 ,房间隔中部 3例 ,右心房高侧壁 2例。消融成功部位的心房内心电图较 P波提前 (42± 12 ) m s。终止房性心动过速初始放电能量均为 15 W,时间均在5 s内。放电次数 2～ 6次。X线曝光时间 (38± 16 ) min。结论　多极标测导管粗标 ,消融导管经 Swartz鞘细标寻找最早心房激动消融右心房房性心动过速的方法简单有效

Ablation of right atrial tachycardias through general mapping of multipolar catheter and careful mapping of ablative catheter through swartz sheath

Objective To investigate the methods of mapping and ablation for right atrial tachycardia. Methods 12 patients with right atrial tachycardias were confirmed as intra-atrial reentry tachycardias by routine electrophysiologic examination. Multipolar mapping catheter was curved and rotated in the right atrium to map the different atrial walls for finding the site of relative early atrial electrogram preceded the P wave in the surface electrocardiogram during tachycardia. Then ablative catheter was used to map carefully near this site through Swartz sheath to locate the earliest site of atrial activation where radiofrequency energy was delivered. The energy was titrated from 15W to 25W. Results Ablation was successful in all twelve patients without any complication and recurrence druing a follow-up perriod of (26±14)months. The sites of successful ablation located near coronary sinus ostium in 5 patients, near the His bundle in 2 patients, in the middle of atrial septum in 3 patients, in the high-lateral wall of right atrium in 2 patients. The local atrial electrograme preceded the onset of the P wave by (42±12) ms at the successful ablation site. The atrial tachycardias were terminated by using 15W of power for less than 5s. Successful ablation in the 12 patients required 2～6 radiofrequcency energy applications and (38±16) min fluoroscopy time. Conclusion It is simple and effective that radiofrequency ablation of right atrial tachycardia was guided by general mapping of multipolar catheter and careful mapping of ablative catheter through Swartz sheath to locate the site of earliest atrial activation.