心房颤动左心房内线性消融后的非典型性心房扑动

The atypical atrial flutter post the catheter linear ablation of atrial fibrillation

目的 左心房线性消融治疗心房颤动 (AF)后的非典型性心房扑动 (AAF)值得引起重视。方法 2 4例患者 (男性 2 0例 ,女性 4例 ) ,年龄平均 5 1 2± 10 9(2 2～ 6 7)岁 ,左心房内径 33 9± 5 5(2 2～ 4 2 )mm。其中阵发性AF(PAF) 19例 ,持续性AF 5例。均在非接触式标测的指导下在左、右肺静脉口外进行环行消融 ,并在顶部肺静脉口间及二尖瓣环峡部行线性消融。在AF终止后经冠状静脉窦进行程序刺激以检验效果并观察是否存在AAF。结果 全部 19例PAF患者中 ,18例的左心房内线性消融获即时成功 ,1例经体外电转复 ;5例持续性AF者有 4例在消融后电转复成功 ,1例未能转复。共有 5例诱发出左心房AAF ,1例被超速抑制 ,2例在左心房顶部左、右肺静脉口之间 ,2例在二尖瓣峡部消融终止了AAF。在随访 7 5± 7(1～ 30 )月 ,除在肺静脉口间消融成功的 2例之外 ,其余 3例AAF均复发 ,2例服抗心律失常药物控制可维持窦性心律为主 ,1例因为 4∶1AV传导无症状而不愿接受治疗。结论 在左心房内进行线性消融治疗房颤存在引发非典型性房扑的可能 ,所采用的消融导管类型可能对其也存在一定影响 。

Objective To highlight the atypical atrail flutter (AAF) post left atrial linear ablation Methods Twenty four patients (20 men, mean age: 51 2±10 9 years) were enrolled, of whom 19 were in frequent paroxysmal atrial fibrillation (AF) and 5 in chronic AF The mean diameter of left atrium (LA) was 33 9±5 5 (22-42) mm The circumferential isolation was performed by encircling the left and right sided pulmonary veins 0 5 to 1 cm from the ostia and was guided by non contact mapping system; ablation lines also were created between pulmonary veins on the roof of left atrium and in the mitral isthmus Results AF was terminated by ablation in 18 patients and by conversion in 5 AAF was induced in 5 patients and was terminated by ablation in 4 and burst stimulation in 1 There were 3 patients who had AAF recurrence during a 7 5±7 (1-30) month follow up and anti arrhythmia agents were needed Conclusion This study suggests that the atypical atrial flutter may occur after left atrium linear ablation and the catheter used may play a role in the course