Lasso电极导管指导下标测与射频消融局灶性房性心动过速

Fast mapping and radiofrequency ablation of focal atrial tachycardia guided by Lasso catheter

目的探讨10极Lasso电极导管对局灶性房性心动过速(房速)标测及射频消融的指导作用。方法局灶性房速病人5例,接受电生理检查,初步判断房速起源于左心房或右心房;应用Lasso电极标测心房,指导消融导管寻找局灶性房速最早心房激动(A波)点,于最早心房激动点处消融。结果局灶性房速病人5例均在房速持续发作时进行Lasso电极标测;消融导管在Lasso电极指导下分别于左心房耳部(2例)、左上肺静脉口部(1例)、上腔静脉(1例)、右心房侧壁(1例)标测到最早A波;较P波提早30～40ms;Lasso电极记录的A波顺序均呈离心性;在上述最早激动点处消融,均成功终止房速,放电次数为1～3次;未出现并发症;随访2～20个月,无复发;手术时间40～60min,X线照射时间8～12min。结论应用Lasso电极指导标测与射频消融局灶性房速,快速、准确,可提高消融成功率,减少X线照射时间,缩短手术时间,特别对病灶位于心内大静脉、心房耳部病例尤有帮助。

Objectives To assess the value of Lasso catheter （10 poles） in guiding mapping and radiofrequency ablation of focal atrial tachycardia （FAT）. Methods Electrophysiological study was performed in 5 patients with FAT, to determine the tachyeardia originated either from left or from fight atrium. The earliest atrial activations （A waves） were mapped by the radiofrequency catheters under guidance of Lasso poles, and the ablation targets were at the earliest activation sites. Results Fast mapping of all FATs guided by Lasso poles was performed during persistent tachycardia. The earliest A waves, 30-40 ms earlier than p waves, were mapped by radiofrequency ablation catheters in two cases at left atrial appendage, one case respectively at ostia of left superior pulmonary vein, superior vena cava and lateral wall of fight atrium. A waves recorded by Lasso catheter were all centrifugal. 5 FATs all were successfully ablated at the earliest activation sites with radiofrequency energy delivery for 1-3 pulses. No complication occurred. During a period of 2-20 months follow-up, no FAT recurred. The procedure time and the fluoroscopic time were 40-60 min and 8-12 min, respectively. Conclusions These results suggest that Lasso catheter mapping may facilitate fast and accurate identification of ablation sites of FAT and may increase successful rate with less fluoroscopic time and procedure time, especially in some cases such as FATs located in large intracardiac veins or atrial appendage.