心脏病外科术后右房房性心动过速的标测及射频消融

摘要

Objective To evaluate the results of mapping and radiofrequency catheter ablation(RFCA) of postsurgical right atrial tachycardia(AT).Methods Twenty-seven patients( 11 men) with postsurgical persistent right AT were enrolled.Electroanatomic mapping of the right atrium was conducted during tachycardia.Activation and voltage maps were used to identify the mechanism of AT and the areas of scar and double potentials.RFCA was performed after targeting the key isthmus or the origin of the tachycardia.Results Tachycardia mechanisms were identified as following: single-loop macroreentrant AT including right atrial isthmus dependent atrial flutter and right atrial incisional AT; double-loop macroreentrant AT; AT with multiple ( more than two) complex mechanisms including AT of focal origin.Immediate ablation success was achieved in all cases, 5 cases suffered from recurrent AT during the follow-up.Successful reablation procedure was achieved in 3 cases.Conclusion Postsurgical AT of right atrium origin is related to surgical scars and RFCA may be effective under the guidance of eletroanatomic mapping.%目的总结分析心脏病外科术后右房起源房性心动过速(简称房速)的标测及射频消融结果.方法共入选27例心脏外科术后持续性右房房速患者,在心动过速状态下采用三维电解剖标测系统建立右房激动标测图和电压图,标示出疤痕区及双电位区,并揭示心动过速的机制.根据标测结果选择心动过速的关键峡部或起源点进行消融.结果心动过速机制分为以下几种类型:单环折返包括右房峡部依赖性心房扑动(15例)和切口折返性房速(5例);双环折返性房速(3例);两种以上机制(包括局灶性)的复杂房速(4例).术中即时手术成功率100%.随访过程中5例复发房速,3例再次消融成功.结论心脏外科术后右房房速多数与外科手术切口疤痕相关,在三维电解剖标测系统指导下射频消融治疗效果满意.