心脏外科手术后房性心律失常的三维电解剖标测和射频消融

目的应用Carto系统对心脏外科手术后房性心律失常患者进行三维电解剖标测和射频消融。方法入选心脏外科手术后房性心律失常患者29例，平均年龄（47±13）岁，男性15例，女性14例。在心动过速时，电解剖标测三维重建右心房和／或左心房。根据双极电图电压确定瘢痕区。对于折返性房性心动过速（房速），线性消融关键峡部或瘢痕区与正常解剖障碍区之间或两瘢痕区间，对于局灶性房速，点消融局部最早激动区域。结果29例患者中，共标测39种心动过速，右心房切口性房速13例（45％），右心房峡部心房扑动（房扑）19例（66％），其中单一出现患者11例（38％），伴发出现患者8例（28％），即时消融成功率93％（27／29），无消融术相关并发症发生。随访（26±20）个月，2例复发，1例再次消融成功。结论心脏外科手术后房性心律失常常见为右心房切口性房速和右心房峡部房扑，Carto电解剖标测系统可有效指导射频消融治疗。

Three dimensional electroanatomic mapping and radiafrequency catheter ablation of postsurgical atrial tachyarrhythmins

Objective To evaluate the efficacy of electroanatomic mapping and radiofrequency catheter ablation(RFCA) of postsurgical atrial tachyarrhythmias under the guide of Carto system. Methods Twenty-nine patients with postsurgical atrial tachyarrhythmias were enrolled. The mean age of patients was (47±13 ) years old,15 male. Electroanatomic mapping of the right or left atrium was conducted during tachycardia. Radiofre-quency ablation was performed under the guide of the activation map and bipolar voltage map. Results Thirty-nine episodes of tachycardia were recorded in 29 patients. Right atrial incisional atrial tachycardia(IAT) was ob-served in 13 cases (45%), right isthmus dependent atrial flutter(RIAFL) was observed in 11 cases (38%), com-bined with RIAFL in 8 cases(28%). Immediate ablation success rate was 93% (27/29),2 recurred during the follow-up of(26±20)months. Success reablation procedure was achieved in 1 case. Conclusions IAT and RIAFL are the common patterns of postsurgical atrial tachyarrhythmias, Radiofrequency catheter ablation may be effective under the guide of electroanatomic mapping in these patients.