持续性心房颤动递进式消融术中房性心动过速的标测和消融

Mapping and ablation of atrial tachycardias encountered during catheter ablation for persistent atrialfibrillation using a step-wise approach

目的阐明持续性心房颤动（房颤）递进式消融术中产生的房性心动过速（房速）的电生理机制。方法持续性房颤行递进式消融术中房颤转化为房速的92位患者入选。通过三维标测系统指导下的电激动标测和拖带标测方法确定房速的机制，并针对心动过速的关键峡部或最早激动点进行消融。结果共标测124例房速，6例（4．8％）为局灶性房速，118例（95．2％）为折返性房速，其中99例（83．9％）为大折返（折返环直径≥3cm），19例（16．1％）为局部小折返（折返环直径〈3cm），17例存在双环或多环折返。术中即刻114例房速（91．9％）消融成功，首次消融术后22位患者复发房速，18位接受多次消融治疗，平均随访（14＋8）个月，共79位（85．9％）患者维持窦性心律。结论对持续性房颤递进式消融术中出现的房速准确标测其机制是可行的，对指导成功消融有重要意义。

To explore the possible mechanism of atrial tachycardias （ATs） during catheter ablation for persistent atrial fibrillation using a stepwise approach. Methods Ninetytwo patients in whom ATs developed during catheter ablation for persistent atrial fibrillation using a stepwise approach were enrolled. ATs were mapped using three-dimensional mapping system and entrainment mapping. Radiofrequency energy was delivered to the critical isthmus or the earliest activation site of ATs. Results A total of 124.ATs were mapped, the focal ATs were detected in 6 patients （4. 8% ） and 118 （ 95.2% ） reentry ATs were recorded, which were fur- ther classified as macroreentry （ the diameter of the eircuit≥3 em） in 99 eases（ 83.9% ） and small local re- entry （the diameter of the circuit 〈3 cm） in 19 cases（ 16. 1% ）. Double or multiple reentry circuits were found in 17 cases. Immediate ablation success was achieved in 114 ATs （91.9%） ,22 patients suffered from recurrent AT. Reablation procedures were performed in 18 patients. After a mean followup of （14 ＋ 8 ） months,79 patients （85.9%） remained in sinus rhythm. Conclusion This study demonstrated the feasibility of mapping of ATs during stepwise ablation for persistent atrial fibrillation, which could be successfully ablated.