低右房电图极性改变评价典型心房扑动射频消融结果

目的　在典型心房扑动 (房扑 )射频消融中观察临近峡部的低位右房心内电图极性改变 ,来迅速判断是否形成峡部双向阻滞。方法　对 10例典型房扑患者 ,沿三尖瓣环放置Halo电极 ,Halo远端紧邻峡部消融线 ,房扑发作中消融在房扑终止后行冠状窦起搏 ,窦性心律下消融则同时行冠状窦电极起搏 ,观察紧邻消融线低右房侧的心房电极电图起始部分的主波方向 (H电位 )的极性表现 ,并与最终双向阻滞评价结果比较。结果　 8例在窦性心律下行冠状窦电极起搏时消融 ,2例在房扑发作中消融。 10例患者最终消融结果均为双向阻滞。 2例房扑发作时H电位极性均为负向 ,8例窦性心律下H电位极性均为正向 ,峡部缓慢传导时该极性仍为正向 ,形成双向阻滞后H电位极性变为负向。结论　典型心房扑动行峡部线性消融时 ,行冠状窦起搏观察到紧邻峡部消融线低右房侧H电位的极性改变可能是峡部消融成功的新指标。该指标简单、快速、可靠性高。

Evaluation of the radiofrequency ablation of typical atrial flutter with a change in the electrogram polarity of low right atrium

Objective To estimate whether a change in the polarity of low atrial electrograms recorded near the ablation line is an accurate indicator of complete isthmus block in the radiofrequency ablation of typical atrial flutter. Methods Radiofrequency ablation was performed in 10 patients with typical atrial flutter. Electrograms were recorded around the tricuspid annulus using a duodecapolar halo catheter and the distal electrode of halo catheter positioned just near the ablation line. The electrogram polarity of the distal electrode pair (H potential) was analyzed during atrial flutter and during coronary sinus pacing before and after ablation. Results Radiofrequency ablation was performed during coronary sinus pacing in 8 patients and performed during atrial flutter in 2 patients. Complete isthmus block was achieved in all patients. Before ablation, the initial polarity of H potential was predominantly positive during coronary sinus pacing and predominantly negative during atrial flutter. After complete isthmus block was achieved, the initial polarity of H potential was predominantly negative during coronary sinus pacing in all the patients. Conclusion The change of the electrogram polarity recorded just near the ablation line during coronary sinus pacing after ablation of typical atrial flutter is a simple, quick and accurate indicator of complete isthmus block.