欧氏瓣对老年人Ⅰ型心房扑动射频消融的影响

Role of Eustachian valve on the radiofrequency catheter ablation of type Ⅰ atrial flutter in elderly patients

目的探讨欧氏瓣对Ⅰ型心房扑动(简称房扑)导管射频消融即刻效果的影响。方法28例老年Ⅰ型房扑患者(呈逆钟向折返18例,顺钟向折返10例)在透视解剖标志和Halo电极三尖瓣环标测电图指引下,在房扑发作或冠状窦口起搏时以温控方式消融位于三尖瓣口和下腔静脉口之间的后峡部,消融方向从三尖瓣叶右室侧到下腔静脉开口。预设温度70℃,每点消融30s,每次移动消融电极3～5mm。观察下列指标:①房扑终止和后峡部阻滞时消融电极在消融线上所处的位置;②房扑终止后峡部残存传导间隙在消融线上所处的位置;③房扑终止后继续消融致后峡部完全阻滞的最终消融部位。结果根据右前斜位30°透视影像测得后峡部平均弧长(即消融线)为38.6±9.7mm。28例全部达到后峡部完全阻滞的消融终点,无并发症。与欧氏瓣有关的房扑终止率为100%(17/17),与欧氏瓣有关的后峡部完全阻滞发生率为92.9%(26/28)。结论欧氏瓣是Ⅰ型房扑后峡部消融线终点的重要标志,线性消融时欧氏瓣心室侧易残存传导间隙,消融该部位的残存传导间隙是Ⅰ型房扑后峡部消融的重要环节。

Objective To evaluate the role of Eustachian valve on the radiofrequency ablation of type-1 atrial flutter in elderly patients. Methods Twenty-eight elderly patients with type-1 atrial flutter （ male 19, mean age 73.6 ± 11.4 years old） were enrolled. Eighteen cases were anti-clockwise reentrant and 10 clockwise reentrant. Posterior isthmus was ablated by the guidance of fluoroscopic anatomical markers and tricuspid electrocardiogram mapping of Halo catheter during atrial flutter or coronary sinus pacing. Ablation catheter moved point by point from tricuspid ring to the orifice of the inferior vena cava. The pre-set ablation temperature was 70℃. Each target point was ablated in 30s. Each moving step was 3 -5mm. Following parameters were recorded： （1）ablation electrode location at atrial flutter termination and posterior isthmus conduction blocked. （2）residual conduction gap location after atrial flutter termination. （3）the final ablation point which caused complete posterior isthmus conduction blocked. Results Posterior isthmus length on 30 degree of right anterior oblique fluoroscopy was 38.6± 9.7mm. Ablation time, actual temperature and energy delivery time were 8.5 ± 3.7, 58.2 ± 9.1 ℃, and 754.8 ±92.3 s respectively. Atrial flutter termination related to Eustachian valve was 100% （ 17/17 ）. Complete posterior isthmus conduction blocked related to Eustachian valve was 92.9% （26/28）. Conclusions Eustachian valve is an important electro-anatomical structure of the posterior isthmus. The complete isolation to the residual conduction gap near Eustachian valve is critical to the cure of type-1 atrial flutter in elderly patients.