房颤患者环肺静脉电隔离术后快速性房性心律失常的再消融治疗效果分析

目的:观察心房颤动患者环肺静脉电隔离术(CPVI)后快速性房性心律失常(ATa)的再消融治疗效果,并探讨其可能的发生机制。方法:64例阵发性房颤患者在初次行CPVI后(3.7±2.4)个月再次行电解剖标测系统指导下ATa标测和消融。结果:共标测到78种ATa,其中48种(61.5%)为局灶性机制,30种(38.5%)折返机制。在折返机制中,12例为普通房扑,18例为左房内折返,其折返环与二尖瓣峡部、左房前壁及原环肺静脉消融线上的传导间隙有关。2例患者因ATa不稳定而无法标测。64例患者中,56例(87.5%)消融即刻成功,8例需要电复律成窦性心律。术后随访13~21个月,平均(16.5±2.9)个月,60例(93.8%)患者不再发生ATa。结论:CPVI术后ATa的机制可为折返性和局灶性,可通过CARTO系统激动顺序标测成功消融治疗。

Outcomes of radiofrequency ablation in atrial tachyarrhythmia patients following circumferential pulmonary vein isolation

Objective:To observe the outcomes of radiofrequency ablation in patients with atrial tachyarrhythmia(ATa) after circumferential pulmonary vein isolation(CPVI),so as to discuss the related mechanism.Methods:A total of 64 patients underwent mapping and ablation using an electroanatomic mapping system(CARTO)at a mean of(3.7±2.4)months after the first CPVA procedure.Results;A total of 78 types of ATa were mapped,including 30(38.5%)with re-entry mechanism and 48 (61.5%)with focal mechanism.Among reentrant ATa 12 had common atrial flutter and 18 had left atrial re-entryt the reentrant circuits were related tO the mitral isthmus,the anterior wall of the left atrium,and the gaps on previous encircling lines.The tachycardias were unstable in 2 patients and were not mapped.Catheter ablation was successful in 56 of the 64 patients (87.5%),and cardioversion was needed in 8 patients to achieve sinus rhythm.During a mean follow-up of 13-21(16.5±2.9) months,60(93.8%)cases no longer had ATa.Conclusion:ATa after CPVA can have macro-reentrant and focal mechanisms.These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.