老年左房前壁自发性瘢痕相关心房扑动的电生理特征及分析

目的:探讨老年患者左房前壁自发性瘢痕相关心房扑动(房扑)的电生理特征及消融预后。方法:选择2018年1月至2020年1月复旦大学附属闵行医院收治的左房前壁自发性瘢痕相关的老年房扑患者5例,行电生理检查及三维电解剖指导下的射频消融术,平均年龄(76.6±10.5)岁,均为持续性房扑。术中通过激动标测、拖带标测以及电压标测等技术,确定房扑的诊断、机制、关键峡部及其与左房前壁自发瘢痕和低电压区的关系。结果:5例患者左房扩大,其中3例升主动脉内径增宽。5例患者均在左房前壁标测到低电压区和瘢痕区,多位于左房前壁靠近升主动脉压迹的部位。房扑均为折返性,关键峡部位于局部低电压区,消融后均成功终止房扑。其中1例因左房内径较大,同时行环肺静脉电隔离;1例复发,行二次消融。平均随访(15.6±4.2)个月后无复发。结论:左房前壁自发性瘢痕是部分老年患者左房房扑的发病基质,房扑的机制为折返性;左房内径扩大、升主动脉内径增宽可能与左房前壁瘢痕区和低电压区的形成相关。

Electrophysiological characteristics and analysis of the elderly patients with atrial arrhythmias related to spontaneous scar on the anterior wall of the left atrium

Objective: To explore the electrophysiological characteristics and ablation prognosis of atrial flutter in elderly patients, which was associated with the spontaneous scar on the anterior wall of the left atrium. Methods: Electrophysiological examination and radiofrequency ablation (RFA) were performed in 5 elderly patients (3 males and 2 females) from January 2018 to January 2020 in Minhang Hospital, Fudan University. These 5 elderly patients with atrial flutter associated with spontaneous scar on the anterior wall of the left atrium received radiofrequency ablation guided by three-dimensional electrical anatomy instruction. The average age was (76.6±10.5) years old. All patients had persistent atrial flutter. The diagnosis, mechanism, key isthmus, and the relationship between the spontaneous scar and low-voltage area of the anterior wall of the left atrium, were determined by activation mapping, entrainment mapping, and voltage mapping. Results: Enlarged left atrium was found in all of the 5 cases. The diameter of ascending aorta was widened in 3 patients. Low voltage and scar areas were mapped in the anterior wall of the left atrium adjacent to the pressure trace of ascending aorta in all 5 patients. The mechanism of 5 flutter cases was reentry. The key isthmuses were located in the local low voltage area. After ablation, the atrial flutters were all successfully terminated. One patient underwent circumferential pulmonary vein ablation at the same time because of the enlarged left atrium. And one patient underwent secondary ablation after recurrence. After an average follow-up period of (15.6±4.2) months, no recurrence was found. Conclusions: The spontaneous scar of the anterior wall of the left atrium may be the pathogenesis matrix of atrial arrhythmia in some elderly patients. The mechanism of atrial flutter is reentry. The enlarged left atrial and ascending aorta may be related to the formation of low voltage area of the scar on the anterior wall of the left atrium.