单导管标测在心房扑动射频消融中的意义

目的:探讨单导管标测法在心房扑动(房扑)射频消融中的应用方法和效果。方法:阵发性心房颤动并发房扑患者行肺静脉电隔离术时采用单导管标测法消融房扑30例。所有患者行肺静脉电隔离术后,将10极冠状静脉窦(CS)导管远端2对电极放置于CS内,余位于CS外,并使之有一定的张力,使导管贴靠于三尖瓣环和低右房。用冷盐水灌注消融导管线性消融三尖瓣峡部,房扑发作患者在房扑下消融,窦律患者在CS远端电极起搏下消融,可在术中随时把大头消融导管置于希氏束部位,用于评价是否已完全达双向阻滞,即:起搏CS远端电极,刺激信号至CS近端电极A波的距离大于至希氏束A波的距离,则CS口至低右房单向阻滞;CS近端电极起搏,刺激信号至CS远端电极A波的距离大于至希氏束A波的距离,则低右房至CS口单向阻滞,从而达双向阻滞,CS近端电极起搏所需电压较高,有的患者可达24mA。结果:所用阵发性心房颤动并发房扑患者均成功行三尖瓣峡部线性射频消融,达到双向阻滞,无手术相关并发症,随访4个月～2年,无房扑复发。结论:单导管标测法对房扑患者行三尖瓣峡部线性射频消融操作简单、快速,可完全用于评价消融结果,成功率高,并且节省手术费用。

Implication of cavotricuspid isthmus mapping with single catheter in atrial flutter radiofrequency ablation

Objective:The present study sought to investigate the efficacy and safety of typical atrial flutter transisthmus linear ablation guided by cavotricuspid isthmus mapping with single catheter. Method: 30 patients (18 men aged 38 to 70 years) who had undergone a successful pulmonary vein isolation and cavotricuspid linear ablation procedure were involved.All the patients were routinely performed segmental electrical isolation of pulmonary veins by irrigated radiofrequenly catheter. After pulmonary vein isolation, the decapolar catheter, which was positioned into coronary sinus, was withdrawn and positioned spanning the tricuspid isthmus so that 2 adjacent dipoles were bracketing the targeted cavotricuspid isthmus (CTI) line of block (LOB) with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. To verify complete bidirectional conduction block, it was essential to position the mapping catheter across the CTI in order to demonstrate the activation sequence up to the ablation line. Complete isthmus bidirectional conduction block was used as an endpoint for radiofrequency ablation for common atrial flutter. Guided byHis electrogram using radiofrequenly catheter, slow conduction from complete isthmus block after atrial flutter ablation was differentiated. Result:Complete isthmus bidirectional conduction block was achiered at the end of the procedure without any complication.Over a follow-up period of 4 months to 2 years, there was no recurrence of atrial flutter.Conclusion:The method of cavotricuspid isthmus mapping with single catheter in atrial flutter radiofrequency ablation is efficacy and safety. This mapping procedure is simple and may decrease the cost of procedure.