先天性心脏病术后心房内折返性心动过速的射频消融

先天性心脏病术后常常发生心房内折返性心动过速(IART)而且治疗困难。本研究的目的是观察疤痕下方2下腔静脉开口或/和下腔静脉2三尖瓣环峡部消融的疗效。11例患者12种房性心动过速进行电生理检查和射频消融。在双电位区域仔细寻找碎裂电位和A波最早处为消融开始的靶点,并向自身解剖形成的传导障碍区延伸。结果:10例11种房性心动过速射频消融成功,成功率为11/12(91.7%),8种心动过速的成功靶点位于右心房外侧壁疤痕下方,3例为典型心房扑动的峡部。平均放电次数为5±4次。随访17±6个月,10例无心动过速发作。结论:疤痕2下腔静脉之间或/和下腔静脉2三尖瓣峡部消融可以有效的消除先天性心脏病术后的IART。

Radiofrequency Catheter Ablation of Intra-Atrial Reentrant Tachycardia Complicating Surgery for Congenital Heart Disease

Intra-atrial reentrant tachycardia (IART) occurs frequently after surgery for congenital heart disease and is difficult to treat. We tested the hypotheses that IART in patients who had undergone prior reparative surgery for congenital heart disease could be successfully ablated by targeting a protected isthmus of conduction bounded by natural and surgically created barriers.11 consecutive patients with 12 IART complicating surgery for congenital heart disease underwent electrophysiological study and ablation attempts. Sites for ablation were sought that demonstrated the presence of broad fractionated electrograms in the area with discrete split potentials. These sites were considered to be within a narrow isthmus critical to the tachycardia mechanism. Anatomic barriers bordering the critical isthmus of conduction were identified on anatomic grounds, by the presence of areas of electrical silence or by the demonstration of split potentials signifying a line of block. Success was achieved in 10 patients with 11 arrhythmias. The median number of radiofrequency application was 5. The successful ablation target zone was at sites near atrial incisions in 9 patients, the typical atrial flutter isthmus was part of the circuit in 3 patients. At a mean duration of follow-up of 17±6 months,10 patients were asymptomatic and did not require antiarrhythmia therapy. Conclusions: Successful ablation of IART complicating surgery for congenital heart disease may be achieved by creation of an ablative lesion in a critical isthmus of conduction bounded by anatomic barriers.