| 摘要: |
| 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。 |
| 关键词: 心房颤动 导管消融术 房性快速性心律失常 环肺静脉电隔离术 |
| DOI：10.3724/SP.J.1008.2009.01264 |
| 投稿时间：2009-04-01修订日期：2009-11-01 |
| 基金项目: |
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| Outcomes of radiofrequency ablation in atrial tachyarrhythmia patients following circumferential pulmonary vein isolation |
| SHI Guo-ping1,2△,SHI Hai-feng1△,LIU Xu1* |
| (1.Department of Cardiology,Affiliated Chest Hospital of Shanghai Jiaotong University,Shanghai 200030,China;2.Department of Cardiology, People’s Hospital of Rugao,Rugao 226500) |
| Abstract: |
| 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-entry; 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. |
| Key words: atrial fibrillation catheter ablation atrial tachyarrhythmia circumferential pulmonary vein isolation |
