摘要
目的探讨不用Halo电极消融典型心房扑动(AF)的方法和右心房峡部传导时间间期的意义。方法对9例AF患者进行了心脏电生理检查和射频消融。将普通标测电极分别放置高位右房(A点)、低位右房(B点)、希氏束(C点)、冠状窦(CS34为D点),标测AF发作时右房激动顺序,起搏时和消融后测量右心房峡部传导时间间期(BD、DB)。结果不用Halo电极成功消融9例AF病例。消融后于冠状窦口处起搏时起搏信号至右房下侧壁的时间间期(DB=140.7ms±66.1ms)和右房下侧壁起搏时起搏信号至冠状窦口CS34的时间间期(BD=123.2ms±42.1ms)均较消融前(DB=66.0ms±12.5ms,BD=62.5ms±13.0ms)明显延长,P<0.01。结论不用Halo电极能成功消融典型AF,该方法简便、费用低;右心房峡部传导时间间期的定量测定可作为判断峡部完全性双向传导阻滞的方法之一。
Objective： To describe the approach to radiofrequency ablation of typical Atrial flutter （AFL） without Halo electrode catheter and the significance of the time conducting through the inferior cava-tricuspid isthmus. Methods： Nine patients with AFL were performed conventional electrophysiological study and radiofrequency ablation （RFCA）. Quadripolar or decapolar electrode catheters were introduced percutaneously through the femoral veins and the right vena jugularis interna, and positioned in the right atrium. Three of them were placed along the anterolateral wall （HRA, point A）, the inferolateral wall （LRA, point B） and the septal wall （His, point C）, respectively, and one was introduced into the coronary sinus （CS, CS34 is point D）. Right atrial activation sequences were investigated during the entrainment of typical AFL. The time of conducting through the inferior vena cava-thricupid annulus （IVC-TA） isthmus （BD and DB） were measured during pacing and after radiofrequency ablation. Results： A counter-clockwise rotating wavefront （D→C→A→B→D） was observed in all patients during AFL. Linear isthmus radiofrequency ablation was guided by electroanatomic mapping, and isthmus bidirectional block was verified by pacing B and D. BD were longer than that before RFCA. Conclusions： These data suggest the approach to RFCA of AFL without HALO electrode catheter is effective. The change of the time conducting through the IVC-TA isthmus can be used as a new, complementary and quantitative electrophysiological end point for the procedure.
关键词
心房扑动
射频消融
电生理检查
Atrial flutter
Radiofrequency ablation
Electrophysiological study
