摘要:目的:探讨三维电解剖标测系统(CARTO)指导下进行房性心动过速射频消融的方法及效果。方法:对40例房性心动过速患者应用CARTO标测心房, 构建三维电解剖图,分析房性心动过速的电生理机制。局灶性房速消融最早激动点,大折返性房速消融折返环的关键性峡部。选择利用常规方法行消融的28 例患者作为对照组。比较两组消融的成功率、X线曝光时间。结果:38例患者CARTO三维标测系统标测提示为局灶性房性心动过速, 最早激动点位于右心房35例,其中冠状静脉窦口8例(20%)、间隔部10例(25%)、侧壁8例(20%)、上腔静脉口附近4例(10%)、后壁4例(10 %),1例患者(2.5%)有3种类型房速(分别为间隔部、上腔静脉口的局灶房速和三尖瓣峡部依赖的大折返房速)。位于左心房的局灶房速3例,分别位于右上肺静脉口(2.5%)、左上肺静脉口(2.5%)及左心耳(2.5%)。2例患者为大折返房速(5%),1例为三尖瓣峡部依赖性,1例为围绕界嵴的大折返房速。均消融成功(100%),随访4~16个月,均无复发。常规消融组成功率为89.3%(Plt;0.05)。CARTO组X线曝光时间比常规组明显缩短,分别为(13.8±5.5 ) min 和( 30.4±12.9 ) min,差异有统计学意义（Plt;0.05）。结论:应用CARTO标测房性心动过速, 对分析房性心动过速的机制准确快速, 能有效指导射频消融。Abstract: Objective: To evaluate the methods and effects of radiofrequency ablation of atrial tachycardia guided by CARTO. Methods: The atria of 40 cases were mapped by three dimensional electroanatomic mapping system. In order to analyse the mechanism of atrial tachycardia and perform the ablation of the earliest excited point in focal atrial tachycardia and isthmus in macroreentry atrial tachycardia. 28 cases ablated by conventional procedure were selected as controlled group. The success rate and fluoroscopic time were compared between the two groups. Results: Focal atrial tachycardia was seen in 38 patients. The sites of origin from right atrium were at the coronary sinus ostium in 8 cases (20%), septal in 10 cases (25%), lateral wall in 8 cases (20%), superior vena cava ostium in 4 cases (10%), posterior wall in 4 cases (10%). One case had 3 types of atrial tachycardia (2.5%). The sites of origin from left atrium were at right pulmonary vein ostium in 1 case (2.5%), left pulmonary vein ostium in 1 case (2.5%), left auricular appendage in 1 case (2.5%). 2 cases were macroreentry atrial tachycardia (5%). Ablation was performed successfully (100%) without any complication. No recurrence was found during a followup of 416 months. Success rate in conventional group was 89.3%(Plt;0.05)。Comparing the CARTO group and conventional group, the fluoroscopic time was shorter, ( 13.8±5.5 ) min vs ( 30.4±12.9 ) min （Plt;0.05).Conclusion: The mechanism of atrial tachycardia can be evaluated quickly and accurately. Ablation can be performed safely and effectively guided by CARTO.
ObjectiveTo investigate heart rhythm outcomes of radiofrequency ablation (RFA)of atrial fibrillation (AF)during mitral valve replacement (MVR)for patients with rheumatic heart disease (RHD), and explore clinical results of radiofrequency catheter ablation (RFCA)for postoperative atrial tachycardia (AT). MethodsEleven RHD patients who developed AT after RFA of AF during MVR were enrolled in this study. There were 4 males and 7 females with their age of 49±8 years. Electroanatomic mapping of the left or right atrium was conducted with three-dimensional electroana-tomic mapping system during continuous AT. RFCA was performed at the key areas of AT. ResultsFor MVR, operation time was 149±18 minutes, postoperative hospital stay was 9.5±2.9 days, and length of ICU stay was 1.8±0.4 days. During electroanatomic mapping, 17 ATs were recorded in 11 patients. Six ATs (35%)of 5 patients originated from the right atrium and 11 ATs (65%)of 6 patients originated from the left atrium (LA). Among them, AT of 2 patients was related to the mitral valve ring. Immediate success of RFCA was obtained in 91% (10/11). After a mean follow-up of 17±4 months, 2 patients whose AT originated from LA had AT recurrence. ConclusionsMajority of postoperative ATs originate from LA, and majority of ATs are not mitral-dependent. RFCA is an effective and safe procedure for AT in patients after RFA of AF during MVR.