知识与财富的链接
目的:观察心房颤动患者环肺静脉电隔离术(CPVI)后快速性房性心律失常(ATa)的再消融治疗效果,并探讨其可能的发生机制。方法:64例阵发性房颤患者在初次行CPVI后(3.7±2.4)个月再次行电解剖标测系统指导下ATa标测和消融。结果:共标测到78种ATa,其中48种(61.5%)为局灶性机制,30种(38.5%)折返机制。在折返机制中,12例为普通房扑,18例为左房内折返,其折返环与二尖瓣峡部、左房前壁及原环肺静脉消融线上的传导间隙有关。2例患者因ATa不稳定而无法标测。64例患者中,56例(87.5%)消融即刻成功,8例需要电复律成窦性心律。术后随访13~21个月,平均(16.5±2.9)个月,60例(93.8%)患者不再发生ATa。结论:CPVI术后ATa的机制可为折返性和局灶性,可通过CARTO系统激动顺序标测成功消融治疗。
Objective:To observe the outcomes of radiofrequency ablation in patients with atrial tachyarrhythmia(ATa) after circumferential pulmonary vein isolation(CPVI),so as to discuss the related mechanism.Methods:A total of 64 patients underwent mapping and ablation using an electroanatomic mapping system(CARTO)at a mean of(3.7±2.4)months after the first CPVA procedure.Results;A total of 78 types of ATa were mapped,including 30(38.5%)with re-entry mechanism and 48 (61.5%)with focal mechanism.Among reentrant ATa 12 had common atrial flutter and 18 had left atrial re-entryt the reentrant circuits were related tO the mitral isthmus,the anterior wall of the left atrium,and the gaps on previous encircling lines.The tachycardias were unstable in 2 patients and were not mapped.Catheter ablation was successful in 56 of the 64 patients (87.5%),and cardioversion was needed in 8 patients to achieve sinus rhythm.During a mean follow-up of 13-21(16.5±2.9) months,60(93.8%)cases no longer had ATa.Conclusion:ATa after CPVA can have macro-reentrant and focal mechanisms.These arrhythmias can be successfully mapped and ablated with an electroanatomic mapping system.
