射频消蚀右心房治疗心房扑动

Radiofrequency catheter ablation in atrial flutter

对８例阵发性心房扑动（房扑）患者，于右心房冠状窦口周围、下腔静脉开口和三尖瓣环之间，记录到双电位伴碎裂电位，并较体表心电图Ｆ波提前≥４０ｍｓ部位进行射频消蚀。５例常见型房扑消蚀成功，３例合并非常见型房扑者未能获得成功。平均随访５个月，２例复发。

Abstract Catheter ablation of atrial tissue using radiofrequency(RF) energy may prevent recurrences of atrial flutter(AFL). We examined the safety and efficacy of RF ablation in the right atrium for AFL in 8 patients(Pts), 5 with inverted F waves (common type) and 3 accompanied with upright F waves (uncommon type) in ECG leads II, III and aVF. RF ablation directed to the atrial isthmus around the coronary sinus ostium (CSo) , between the inferior vena cava (IVC) and the tricuspid annulus (TVA). A bipolar and unipolar electrograms were recorded from the same catheter at the same time. The characteristics of the local electrograms at the ablation target were as follows : (1) Double-spike potential with fragmented electrogram; (2) Concealed entrainment during pace mapping; (3) The earliest atrial activation (40 msec before the F wave onset) during AFL. RF (25～40 watt) applied (3～17 applications) was effective in terminating AFL and preventing reinduction of AFL in 5 pts with common type of AFL but failed in the other 3 cases. Follow-up study showed two of the five recurred, the original AFL in one patient and new type of AFL in another patient. Conclusions: (1) A critical area in the reentrant circuit of typical inverted F wave AFL (probably near or in the exit from the area of slow conduction) can be used for RF ablation of AFL;(2) This area may not be suitable for uncommon type of AFL, probably due to small lesion size or multiple reentrant circuits; (3) Long-term outcome should be followed up since atrial arrhythmia might develop if these myocardial abnormalities progressed.