CARTO标测指导射频消融治疗非峡部依赖性心房扑动的初步研究

初步探讨非峡部依赖性心房扑动 (简称房扑 )———非典型房扑CARTO标测的方法学和射频消融效果。 4例经电生理标测证实的非典型房扑患者 ,男、女各 2例 ,年龄 2 4～ 5 7岁。 1例为先天性心脏病 (简称先心病 )三房心外科术后 ,1例为慢 快综合征。房扑发作时在右房或左房CARTO标测 ,三维重建右房或左房 ,寻找房扑折返径路的关键峡部区域行线性消融。结果 :3例为右房非峡部依赖性房扑 ,1例消融径线为 2条 ,即三尖瓣环至下腔静脉(IVC)口和右房后外侧至IVC ,1例消融径线为右房前中外侧 ,1例为右房下外侧。 1例左房房扑 ,消融径线位于右上肺静脉口下方至卵园窝。 4例均即时消融成功。随访 8～ 2 4个月 ,有 1例先心病术后房扑复发 ,再次行CARTO标测发现房扑折返环位于左房 ,划线消融未成功。结论 :CARTO标测非峡部依赖性房扑有一定的优势 ,能显示房扑折返环和关键峡部 ,并能指导线性消融

Primary Study of CARTO Mapping and Radiofrequency Catheter Ablation for Isthmus Independent Atrial Flutter

Department of Cardiology,Guangdong Province People′s Hospital,Guangzhou 510800,ChinaThis study is to investigate the methodology of 3 D electroanatomic mapping system (CARTO mapping system,Biosense Cordis Webster) and benefits of radiofrequency catheter ablation for isthmus independent atrial flutter (AFL) (or atypical AFL).Four patients (male 2,female 2,age 24～57 years) with atypical AFL were performed by electrophysiological testing.Of 4 patients,one case had congenital heart disease (CHD) with three atria being undergone by surgical operation,one case had bradycardia-tachycardia syndrome.Right atrium (RA) or left atrium (LA) mapping was performed to demonstrate the reentrant circuit during tachycardia with CARTO system.Linear radiofrequency (RF) ablation of critical isthmus in reentrant circuit was attempted.Results:There were 3 patients with RA isthmus independent AFL being identified by CARTO mapping.Ablative line was designed with CARTO mapping from the tricuspid annulus to the inferior vena cava (IVC) and from right posterior lateral wall to IVC in one patient,right anterior medi lateral wall in one patient and right inferior lateral wall in one patient.There was one patient with LA isthmus independent AFL,whose ablative line was demonstrated with CARTO mapping from the ostium of right superior pulmonary vein (RSPV) to fossa ovale.Four patients with atypical AFL had instantaneous successful ablation.After the follow up of 8～24 months,one patient with atypical AFL with CHD recurred and underwent another unsuccessful ablation under the guide of CARTO mapping.Conclusion:This study suggests that CARTO system mapping for isthmus independent AFL has an adventage of demonstrating the critical isthmus in the reentrant circuit and directing linear RF ablation.