心房颤动射频消融术后继发房性心律失常的机制和对策

目的 研究心房颤动(AF)患者环肺静脉射频消融术后继发房性快速性心律失常(ATA)的机制和对策.方法 继发ATA 15例.左房各肺静脉逐一标测,对恢复心房-肺静脉传导的静脉补点消融,达到心房-肺静脉电隔离.成功后仍然存在或诱发ATA的则进行CARTO激动标测和拖带标测,并行辅线消融或局灶消融,直到不能诱发.结果 经电生理标测发现14例恢复了心房-肺静脉传导.相应补点消融后电隔离,9例不能再诱发,3例诱发了左房大折返心动过速,左房顶部/峡部消融后终止,1例诱发左房局灶心动过速,局灶消融后成功.2例诱发右房大折返心动过速,右房峡部消融后消失.术后随访1～16(5.5±4.4)个月,13例无复发,2例发作明显减少.结论 左房-肺静脉传导恢复是继发ATA的重要机制;其他机制还包括左房顶部、峡部、右房峡部依赖的大折返心动过速以及局灶房性心动过速等.对继发ATA,先检查肺静脉并补点消融很重要,但不能完全解决问题,尚需根据CARTO激动标测和拖带标测进行个体化的消融.

Mechanism and re-ablation strategy for postablation atrial tachyarrhythmia in atrial fibrillation patients

Objective To investigate the mechanism and re-ablation strategy of recurrent atrial tachyarrhythmia (ATA) following circumferential ablation of pulmonary veins (PV) in patients with atrial fibrillation (AF).Methods Fifteen patients with recurrent ATA following first AF ablation procedure were included in this study.Under CARTO guidance,PVs were remapped and ablated subsequently for relapse of left atrium to PV conduction.The whole atrium was then remapped and individualized ablation was made to eliminate inducible ATA.Results Left atrium to PV conduction relapses were evidenced in 14 patients.After re-ablation,there were no inducible ATA in 9 patients,inducible left atrial macro-reentry tachycardia in 3 patients and all were terminated by further linear ablation on the roof and left atrial isthmus,inducible atrial focal tachycardia from left atrial isthmus in 1 patient and was eliminated after additional focal ablation.inducible right atrial macro-reentry tachycardia in 2 patients and were eliminated by right isthmus linear ablation.During 1-16 (5.5±4.4) months follow-up,ATA was disappeared in 13 patients and reduced in another 2 patients.Conclusions Relapse of left atrium to PV conduction is one of the main mechanisms for postablation ATA in patients with A F.Atrial macro-reentry tachycardia and focal atrial tachycardia were less common mechanisms for postablation ATA.Re-ablation focused on closing the PV gaps and additional individualized focal and lineal ablation strategies were helpful for treating postablation ATA in AF patients.