论文部分内容阅读
目的:探讨房性心动过速(房速)下激动标测和电压标测在心房颤动(房颤)射频消融术后复发房速中的应用价值。方法:连续纳入2019年5月至2019年9月在浙江大学医学院附属邵逸夫医院心内科接受再次导管消融手术的房颤术后复发房速患者17例，其中男8例，年龄(67.2±7.5)岁。三维标测系统指导下，采用激动标测结合电压标测，明确复发房速的机制及发病部位并进行相应消融。结果:17例患者电生理检查中均出现或诱发出房速，并对17例患者标测中发作的27种阵发性房速心律进行激动标测、电压标测及拖带标测，并成功进行了射频消融。术中标测提示，无论是对于折返性房速或是局灶性房速，均可在折返环路径或局灶起源区域记录到低电压区。术后经过(13±2)个月随访，16例无房颤/心房扑动(房扑)/房速复发，1例复发房颤。结论:房速心律下心房电压标测，有助于判断房速折返机制和可能关键峡部，提高消融效率和消融准确性。部分房颤消融术后复发房速的机制，与既往左心房消融病灶相关。“,”Objective:To investigate the value of excitation mapping and voltage mapping in recurrent atrial tachycardia after radiofrequency ablation of atrial fibrillation.Methods:Seventeen patients with recurrent atrial tachycardia after atrial fibrillation ablation [8 males, age (67.2±7.5)years] were included in Department of Cardiology, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University.Under the guidance of three-dimensional mapping system (Carto), activation mapping and voltage mapping were used to clarify the mechanism and location of recurrent atrial tachycardia, and corresponding ablation was performed.Results:Atrial tachycardia appeared or induced in the electrophysiological examination of 17 patients.In 17 patients, 27 atrial tachycardia rhythms were observed by excitation mapping, voltage mapping and drag mapping.And radiofrequency ablation was successfully performed.Intraoperative mapping showed that low-voltage areas could be recorded in reentrant loop pathway or in focal origin area.During the(13±2) months follow-up, 16 cases (94%, 16/17) had no recurrence of atrial fibrillation/atrial flutter/atrial tachycardia, and 1 case had recurrent atrial fibrillation.Conclusion:Atrial voltage mapping under atrial tachycardia rhythm is key isthmus, and improve the ablation efficiency and accuracy.The mechanism of recurrent atrial tachycardia after partial atrial fibrillation ablation is related to previous left atrial ablation lesions.