导管消融心脏病术后心房内大折返性心动过速

目的:报道应用常规和三维电生理标测方法经导管消融心脏病术后心房内折返性心动过速(IART)的疗效和安全性。方法:选择2002年1月～2006年2月在我院因心脏病术后心房内折返性心动过速行射频消融的44例患者,早期采用常规电生理标测方法,之后随机采用Carto和Ensite三维标测方法指导导管消融。结果:44例患者共诱发出54种心房内折返性心动过速,其中37种(37/54,68.5%)心房内折返性心动过速心电图表现为典型心房扑动(AFL)锯齿形F波,31种心房扑动(31/54,57.4%;31/37,83.8%)成功靶点在下腔静脉和三尖瓣环(IVC-TA)峡部,4种心房扑动成功靶点在疤痕和下腔静脉峡部,2种心房内折返性心动过速成功靶点在疤痕和三尖环之间。另外17种(17/54,31.5%)心房内折返性心动过速临床心电图表现与典型房扑不同,表现为P’波,其中15种(15/ 54,27.8%)成功靶点在右心房游离壁疤痕—下腔静脉或疤痕—上腔静脉或疤痕与疤痕之间;房间隔补片和上腔静脉之间、房间隔补片和三尖瓣环之间各消融成功1种。随访1例复发,行2次消融成功。1例出现持续性心房颤动伴RR长间歇,植入永久性起搏器。结论:导管消融心脏病术后心房内折返性心动过速具有较高的疗效和安全性,应当作为首选的治疗方法。

Catheter Ablation of Intra-Atrial Reentrant Tachycardia Following Cardiac Surgery

Objective:The purpose of this study was to analyze the effectiveness and safety of catheter ablation of intra-atrial reentrant tachycardia(IART)following cardiac surgery. Methods:Forty-four patients with IART following cardiac surgery received catheter ablation in our hospital from January 2002 to February 2006.The ablation procedure was guided by three-dimensional mapping system(Carto and Ensite 3000)or routine electrophysiological method. Results:Fifty-four episodes of IART were induced in all patients.In thirty-seven(37/54,68.5%)episodes of IART presen- ted with typical Fwaves were documented on the electrocardiogram(ECG).Of them 31(31/54,57.4%;31/37,83.8%)were terminated successfully at the isthmus between IVC-TA,the other 6 at the isthmus between Scar-IVC.17(17/54,31.5%)epi- sodes of IART showed P'wave morphology on the ECG.The successful ablation targets located at the right free wall(including Scar-IVC isthmus,Scar-SVC isthmus and Scar-Scar isthmus)in 15(15/54,27.8%)and 2(2/54,3.7%)were teminated at the atrial septal patch area. Conclusion:Catheter ablation for IART following cardiac surgery is safe and effective,it could be the first choice of the treat- ment.