摘要
目的:探讨房间隔缺损(ASD)外科修补术后形成房性心动过速(房速)的心脏电生理机制。方法:回顾性分析因ASD术后房速于我院行导管射频消融治疗患者20例,在心动过速时电解剖标测右心房,根据激动标测及电压标测结果指导消融。结果:入选患者共诱发20种心动过速。8例患者为三尖瓣环峡部依赖房速,10例为同时围绕三尖瓣环及右房游离瘢痕的8字型折返,2例为围绕右房游离壁瘢痕顺钟向折返房速。对所有右房游离壁或前壁瘢痕至下腔静脉距离进行测量,双环折返及围绕三尖瓣环单环折返分别为(31±4)mm和(14±2)mm,前者明显高于后者。所有入选患者首次射频消融术成功率为100%,随访(25±14)个月,2例复发。结论:ASD术后患者间隔部位起源房速发生比例低。90%均为三尖瓣环相关房速。游离壁瘢痕至下腔静脉的不连续性为双环大折返房速提供了电解剖基础。
Objective：To evaluate the efficacy of electroanatomic mapping and radiofrequency catheter ablation（RFCA）of atrial tachycardia（AT）after surgical repair of ASD（atrial septum defects）.Method：This retrospective study included 20 patients with AT after ASD.ELectroanatomic mapping of the right atrium was conducted during tachycardia.RFCA was performed under the guide of the activation map and bipolar voltage map.Result：Twenty episodes of right atrium macroreentry tachycardia were recorded in 20 patients.Single-loop cavotricuspid isthmus（CTI）dependent AT was observed in 8cases.Double-loop AT（around the tricuspid annular and the right lateral wall at the same time）was observed in 10 cases.Right atrial incisional AT was observed in 2cases.The distance between right lateral wall scar and IVC（inferior vena cava）was measured.The distance of doubleloop AT group was significantly longer than the single-loop AT group[the former was（31±4）mm and the latter was（14±2）mm].Immediate ablation success rate was 100%,2recurred during the follow-up of（25±14）months.Conclusion：There was lower rate AT originating from interatrial septum in the patients of surgical repair of ASD.CTI dependent AT was the common patterns of postsurgical of ASD ATs.The discontinuity between right lateral wall scar and IVC provides the electroanatomical mechanism for the double-loop AT.
作者
任静
马薇
卢凤民
许静
REN Jing MA Wei LU Fengmin XU Jing(The Fifth Department of Cardiology, Tianjin Chest Hospital, Tianjin, 300000, Chin)
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2016年第11期1129-1134,共6页
Journal of Clinical Cardiology
关键词
房间隔缺损
房性心动过速
电解剖标测
导管消融
atrial septum defects
atrial tachycardia
electro-anatomical mapping
catheter ablation
