导管消融治疗迷宫术后复发房性心动过速的中、远期疗效分析被引量：1

Mid and long-term outcomes of catheter ablation of recurrent atrial tachycardias post Mini-Maze surgery

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摘要目的评价导管消融治疗迷宫术后复发房性心动过速(房速)的中、远期疗效,探讨房速复发的相关因素。方法纳入2010年4月至2015年6月在广东省人民医院接受导管消融治疗的迷宫术后复发房速患者59例。应用三维标测系统进行高密度电解剖标测,结合拖带标测指导导管消融。术后定期随访,采用多因素Cox比例风险回归模型分析导管消融治疗迷宫术后房速复发的危险因素。结果共记录到88种房速,其中1例患者房速为短阵性发作,与窦性心律交替出现,难以进行电解剖标测及拖带标测。平均每例患者有(1.49±0.75)种房速,以折返性房速多见,占76.1%(67/88),局灶性房速占22.7%(20/88)。59例患者中,56例(94.9%)即时消融成功。术后平均随访(30.8±17.7)个月,首次导管消融治疗后3例患者即时消融失败,12例复发,术后复发时间为3.5(1.3,12.0)个月,消融成功率为74.6%(44/59)。6例患者接受再次导管消融治疗,二次导管消融治疗后总体成功率为79.7%(47/59)。多因素分析提示左心房内径为预测复发的独立危险因素(HR1.108,95%CI 1.002~1.226,P=0.045)。结论迷宫术后复发房速患者行导管消融治疗安全、有效,左心房内径是房速消融术后复发的独立危险因素。 Objective To analyze the clinical characteristics and follow-up data of catheter ablation of recurrent atrial tachycardias（ ATs） after Mini-Maze surgery,and to explore prognostic factors for recurrence. Methods 59 patients in Guangdong General Hospital with ATs post Mini-Maze and concomitant open-heart surgery from April. 2010 to June. 2015 were included. According to high density precise mapping, activation mapping, voltage mapping and entrainment mapping, they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system. All patients were followed up regularly. We explored the prognostic factors for recurrence by the Cox regression analysis.Results There were 88 types of ATs being mappedwith mean（ 1. 49 ± 0. 75） types of ATs identified per case. Most ATs were macro-reentry ATs（ 67/88,76. 1%） and focal ATs（ 20/88,22. 7%）,respectively.56 patients（ 94. 9%） achieved immediate ablation success. In a mean follow-up of（ 30. 8 ± 17. 7） months,recurrences were observed in 12 patients after the first time catheter ablation. Recurrent time was 3. 5（ 1. 3,12. 0） months and the overall ablation success rate was 74. 6%（ 44/59）. 6 patients received second ablation and the achievement of freedom from arrhythmias reached 79. 7%（ 47/59）. Multivariate analysis showed that the LA diameter was the independent predictor for recurrence（ HR 1. 108,95% CI 1. 002 to 1. 226,P = 0. 045）. Conclusion Catheter ablation of ATs post Mini-Maze with concomitant surgery is save and feasible. LA diameter is the independent predictor for recurrence.