心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

心房颤动递进式线性消融后的左心房扑动

Objective This study attempted to delineate the mechanism of organized loft atrial tachya-rrhythmia (AT) during stepwise linear ablation for atrial fibrillation (AF) using noncontact mapping. Methods Eighty patients in whom organized ATs developed or induced during stepwise linear ablation for AF were en-wiled. Left atrial (LA) activation during ATs was mapped using noncontact mapping. Radiofrequency energy was delivered to the earliest activation site or narrowest part of the re-entrant circuit of ATs. Results A total of 146 ATs were mapped. Four ATs were characterized as a focal mechanism [cycle length (225 ± 49) ms]. A macro-reentrant mechanism was confirmed in the remaining 142 ATs using noncontact mapping. LA activation time accounted for 100% of cycle length (205±37) ms. All 142 ATs used the conduction gaps in the basic fig-ure-7 lesion line. There were 3 types of circuits classified based on the gap location. Type Ⅰ (n = 68) used gaps at the ridge between left superior pulmonary vein (LSPV) and left atrial appendage (LAA). Type Ⅱ(n = 50) used gaps on the LA roof. Type Ⅲ (n = 24) passed through gaps in the mitral isthmus. Ablation at these gaps eliminated 130 ATs, but the remaining 16 ATs required cardioversion to sinus rhythm due to a poor response to ablation. Conclusion Vast majority of left ATs developed during stepwise linear ablation for AF are macro-reen-trant through conduction gaps in the basic figure-7 lesion line, especially at the ridge between LSPV and LAA. Noncontact activation mapping can identify these gaps accurately and quickly to target effective catheter ablation.     

递进式消融法治疗持续性心房颤动的初步体会

Objective To evaluate the effect of catheter ablation on persistent atrial fibrillation (AF) using step-wise approach. Methods Thirty-four patients [mean age (54.8 ± 11.4) years] with persistent AF [mean (36.5 ± 9.8) months] underwent catheter ablation were enrolled. Ablation was performed in following sequence. Circumferential ablation of pulmonary veins to achieve isolation, linear ablation of left atrium roof and mitral isthmus, ablation at sites possessing complex fractionated atrial electrograms. Using activation Carto mapping system, if AF converted to atrial flutter (AFL) or atrial tachycardia (AT), then catheter ablation was applied to terminate tachycardia. Results The step-wise ablation approach was successful in rhythm changes (AF converted to AFL/AT) in 88.2% of patients, 61.8% of patients conversion to sinus rhythm directly via ablation. At 12.6 ±6.2 months of follow-up, 82.4% of patients were maintained in sinus rhythm (42.9% of those patients taking oral amiedarone). Conclusion Catheter ablation using step-wise approach is effective in persistent AF treatment.     

Treatment of atrial flutter and rapid atrial tachycardia with transesophageal atrial pacing

Eight patients with atrial flutter (AF) and rapid atrial tachycardia (AT) (5 common AF, 1 uncommon AF and 2 AT) were treated with transesophageal atrial pacing (TEAP). In 5 patients no antiarrhythmic agent was used during this study, and in 3 patients procainamide was administrated intravenously. Conversion to sinus rhythm was successfully achieved in 7 patients (5 common AF and 2 AT). Two patients were converted to sinus rhythm immediately after pacing, and transient atrial fibrillation was induced before conversion to sinus rhythm in 5 patients. TEAP failed to terminate the arrhythmia in 1 patient with uncommon AF. Administration of procainamide reduced the atrial rate in 2 common AF and 1 AT, which were successfully converted to sinus rhythm by TEAP, but induced a rapid ventricular response in 2 patients, one of whom also developed hypotension before conversion. No significant complication due to TEAP was observed in this study. In conclusion, TEAP is a noninvasive method with fewer complications and has nearly the same high efficacy for converting AF and rapid AT to sinus rhythm as DC cardioversion or transvenous atrial pacing.     

心房颤动患者心房组织血管紧张素系统与心房纤维化的关系

目的 探讨心房颤动（房颤）患者血管紧张素系统基因转录和蛋白表达与心房纤维化的关系,研究心房纤维化在房颤维持和心房重构中的作用.方法 心外科手术病人53例,其中窦性心律者26例,房颤患者27例（房颤少于10年患者为房颤Ⅰ组,房颤超过10年患者为房颤Ⅱ组）.术前行超声心动图检查.手术中取右心房组织,Masson染色测定胶原容积分数（CVF）,分别通过逆转录-聚合酶链反应（RT-PCR）和蛋白印迹的方法测量血管紧张素Ⅱ受体、血管转化酶（ACE）mRNA和血管紧张素Ⅱ受体1型蛋白的表达量,用放射免疫的方法测定血管紧张素Ⅱ（AngⅡ）的水平.结果 同窦性心律组相比,房颤组心房扩大、CVF增高;房颤Ⅰ组心房血管紧张素Ⅱ受体1和2的mRNA水平差异无统计学意义,ACE mRNA升高,AngⅡ升高;房颤Ⅱ组心房血管紧张素Ⅱ受体1和2的mRNA有下降的趋势,未达统计学意义,ACE mRNA、血管紧张素Ⅱ受体1蛋白表达下降,有统计学意义.结论 血管紧张素系统在房颤患者的心房纤维化早期发展中发挥作用.     

心房颤动总是"引发"心房颤动吗?

心房颤动(AF)是临床上常见的心律失常,心房重构和AF"引发"AF概念的提出是对AF病理生理机制研究的重大进展,但临床上有关AF的诸多问题并不能都用AF"引发"AF和单纯的心房电重构来解释,本文就AF"引发"AF这一问题结合有关文献作一综述.