右房房性心动过速的电生理特征及其治疗

Electrophysiologic Characteristics and Treatments of Right Atrial Tachycardia

报道６例右房房性心动过速（ＡＴ）的电生理特点及其射频消融（ＲＦＣＡ，４例）或外科手术（２例）治疗的结果。６例（４例合并器质性心脏病）均有反复ＡＴ发作的病史，并经心电图和电生理检查证实为右房ＡＴ：５例为房内折返性心动过速（ＩＡＲＴ）、１例为自律性房速（ＡＡＴ）。５例ＩＡＲＴ均采用激动标测并结合拖带或隐匿拖带寻找ＲＦＣＡ的心房靶点，３例治愈、２例失败。失败者皆因心脏手术后瘢痕所致，其中１例经外科手术在传导组织狭区行线性冷冻治愈。１例ＡＡＴ经外科手术切除右心耳疤痕而治愈。结果表明：ＡＴ的机制研究对指导ＡＴ的ＲＦＣＡ和手术治疗有重要意义，器质性心脏病所致的ＡＴ在ＲＦＣＡ失败后采用手术方法可获治愈。

The electrophysiologic characteristics and treatment results were analyzed in 6 patients who had right atrial tachycardia (AT).4 cases radiofrequency current ablation (RFCA) and 2 cases surgical intervention were attermpted in 6 patients with AT.2 males,4 females,4 cases of 6 patients combined organic heart diseases.All patients had clinical episodes of AT,and the diagnosis was established by ECG recordings and electrophysiology study (EPS) for AT.The causes of AT were automaticity tachycardia (AAT) in one patient and intraatrial reentrant tachycardia (IART) in 5.A combination of activation mapping and entrainment or conceal entrainment was performed in order to fined the ablation points.RFCA success was achieved in 3 of 5 patient.Two were unsuccessful.The causes of unsuccessful RFCA may be residual atrial scars from prerious atrial surgery.Cryolesions were placed to transect the narrowest isthmus of conducting tissue in one patient.Another AAT patient was cured by incision scars of the right atrial appendage.Conclusions:The study on mechanism of AT may be significance for promotion the successful rate of RFCA and operation.Patients with AT combined organic heart disease can be treated by surgical intervention after RFCA failed.