心房颤动环肺静脉隔离术后复发左房房性心动过速的特点及消融治疗

The treatment of recurrent atrial tachycardia originated from left atrium after the circumferential pulmonary veins isolation in patients with atrial fibrillation

目的探讨心房颤动(简称房颤)环肺静脉隔离术后(CPVI)复发左房房性心动过速(简称房速)再次射频消融中,房速机制的鉴别和消融策略的选择。方法18例房颤经CPVI术后复发房速患者,其中男16例,女2例,年龄61.4±6.5(50～70)岁。在持续稳定的自发/诱发房速时在Carto指导下行激动顺序标测,经电生理检测,明确房速机制并选择相应消融方式:对于局灶性房速,重新阻断原消融径线上裂隙或消融最早激动区;对于折返性房速,明确关键峡部,行线性消融,如果有肺静脉电位亦行对裂隙的消融。结果共有13例肺静脉恢复电活动(72.7%)。局灶性房速6例,折返性房速12例(包括11例左房大折返和1例肺静脉-左房折返)。相应方式消融后房速均转为窦性心律,且肺静脉电位消失。结论房颤CPVI术后复发的左房房速与肺静脉电位的恢复密切相关;与消融线和裂隙形成的折返有关。

Objective To evaluate the radiofrequency （RF） ablation for the recurrent atrial tachycardia （AT） originated from left atrium （LA） after the circumferential pulmonary veins isolation （CPVI） in patients with atrial fibrillation （AF）. Methods A repeat procedure was performed in 18 patients with recurrent AT after CPVI. In this procedure, PV conduction was confirmed by Lasso catheter. Activation mapping and entrainment technique were performed with 3-D Carto system to identify the earliest activation area and reentrant circuit. The gaps on the original continuous circular lesions （CCLs） around the ipsilateral pulmonary veins （PVs） were confirmed by the Lasso catheter and mapping catheter. Block the gap and the earliest activation area to terminate focal AT; Block the gap and the reentrant circuit to terminate reentrant AT. Results Recovered PV activation in 13 of 18 patients （72.7%） were demonstrated. Focal AT in 6 patients and re- entrant AT in other 12 patients were confirmed. All conduction gaps were successfully closed with segmental ablation and all AT were terminated by the relevant ablation. One special reentrant tachycardia between PV and LA was indentified and was terminated by blocking the exit on the original CCLs. Condusions Recovered PV spikes were confirmed in almost all patient with recurrent AT after CPVI and the gaps related to AT.