典型心房扑动的经导管射频消融治疗

回顾分析 35例典型心房扑动 (简称房扑 )患者电生理检查和射频消融治疗的临床结果。心内激动标测显示沿三尖瓣环 (TA)逆钟向折返性房扑 2 7例 ,顺钟向折返 2例 ,同时存在二种折返 6例。 8例行TA峡部拖带起搏者均呈隐匿性拖带 ,起搏后间期与房扑周长差值为 1± 4(- 3～ 5 )ms。采用TA峡部双线性消融、后峡部或 /和间隔峡部消融的方法治疗所有患者均成功。 15例以房扑不能再诱发为手术终点 ,随访 10例 ,3例复发 ,复发率 30 % ;2 0例达到TA峡部双向阻滞 ,随访 19例 ,1例复发 ,复发率 5 % ,两组比较P <0 .0 5。随访的 2 9例中 ,7例发生心房颤动 (简称房颤 ) ,发生率 2 4%。与无房颤发作者相比 ,合并器质性心脏病、心房扩大和有房颤病史者的比例明显增加 (6 / 7比 9/ 2 2 ,6 / 7比 4/ 2 2和 7/ 7比 2 / 2 2 ,均P <0 .0 5 )。结果表明 ,心内激动标测结合拖带起搏技术可确定典型房扑的诊断 ,后峡部或间隔峡部消融是治疗房扑的有效方法 ,以TA峡部双向阻滞为手术终点较房扑不能被再诱发为终点可明显降低复发率。房扑消融术后发生房颤与合并器质性心脏病、心房扩大和术前存在房颤有关

Radiofrequency Catheter Ablation of Typical Atrial Flutter

Clinical results of electrophysiological study and radiofrequency catheter ablation(RFCA) of typical atrial flutter(AFL) in 35 patients were reviewed retrospectively.Endocardial activation mapping demonstrated that the atrial activation of AFL around the tricuspid annulus(TA) in the counterclockwise direction in 27 patients,clockwise in 2,and both in 6.Entrainment pacing at the TA isthmus was performed on 8 patients,which showed concealed entrainment.The postpacing interval minus the flutter cycle length was 1±4(-3～5)ms.RFCA eliminated AFL in all patients by ablation of the posterior isthmus in 24 patients and the septal isthmus in 7 or the double ablation lines from the TA to the coronary sinus(CS) and from CS to the inferior vena cava in 6.Ablation success was defined by the inability to reinduce AFL in 15 patients.Among them,10 were followed,in whom AFL recurred in 3(30%).Nineteen of 20 patients with the presence of bidirectional isthmus conduction block at the end of the procedure were followed,in whom AFL recurred in 1(5%).The recurrence rates in two groups had significant difference(30% vs 5%, P<0.05 ).Atrial fibrillation(AF) occurred in 7 of 29 patients(24%) who had been followed during a mean follow up of 18±17 months.Compared with the patients without AF after ablation,these 7 patients had a significantly greater incidence of structural heart disease(6/7 vs 9/22, P<0.05 ),atrial enlargement(6/7 vs 4/22, P<0.05 ) and preablation AF(7/7 vs 2/22, P<0.05 ).The results indicate that the endocardial activation mapping combined with the entrainment pacing can confirm the diagnosis of typical AFL.RFCA of the posterior or septal isthmus in effective for the treatment of typical AFL.The recurrence rates are significantly lower in patients with bidirectional isthmus conduction block compared with patients with noninducibility as a procedural endpoint.The occurrence of postablation AF is associated with the presence of structural heart disease and atrial enlargement and a history of preablation AF.