多极标测在心房颤动消融术后持续性房性心动过速中的应用体会

Application of multielectrode activation mapping and radiofrequency catheter ablation in patients with sustained atrial tachycardia after atrial fibrillation ablation

目的报道EnSite NavX／Velocity系统的多极标测功能在心房颤动（房颤）消融术后持续性房性心动过速（房速）中的应用体会。方法18例房颤消融术后并发持续性房速患者，平均年龄（54．5±12．8）岁，男12例，女6例。心动过速均呈持续性发作，于心房进行多极标测，建立激动图；根据激动图，结合传导图、电压图，对房速机制进行判断，制定消融策略；对于折返性房速，线性消融关键峡部或传导通道（channel），对于局灶性房速，点消融局部最早心房激动区域。结果18例患者中，每例并发1～4种房速，共28种房速行多极标测，周长为（260．7±57．6）ms，平均取点（368．6±152．4）个，标测时间（11．1±3．6）min，共建立27种激动图。激动图显示局灶性或微折返性房速13种；小折返性房速1种（围绕右侧肺静脉2个损伤性“漏点”形成的折返）；大折返性房速13种：围绕二尖瓣环10种，围绕肺静脉经过左心房顶壁形成单环折返2种、双环折返1种。28种房速中，25种即时消融成功，成功率89％；无标测及消融相关并发症发生。手术时间为（122．6±35．0）min，曝光时间为（16．04±5．9）min。随访（11．2±6．6）个月，18例患者中，4例复发，2例服用胺碘酮可维持窦性心律。结论应用EnSite NavX／Velocity系统的多极标测功能，易达到高密度标测效果，有助于房速机制的快速判断及消融策略的制定，可提高房颤术后持续性房速的消融成功率。

Objective To explore the application of multielectrode activation mapping by EnSite NavX/Velocity mapping system in sustained atrial tachycardia （AT） after atrial fibrillation （AF）abla-tion. Methods Eighteen patients with sustained AT after AF ablation in our hospital were retrospectively ana-lyzed. Among the 18 pts, the mean age was（54. 5±12. 8）years （male 12 pts, female 6 pts）. All patients were guided by multielectrode activation mapping by NavX/Velocity mapping system. The activation sequences of AT were mapped. Radiofrequency catheter ablation was performed at the critical reentry isthmus or the focal origin by constructing three-dimensional model of atrium. Results Twenty-eight types of AT were presented in 18 pa- tients. The average cycle lengths of AT were （260. 7±57. 6）ms. The mean multielectrode mapping points were （368.6±152.4）. The mean muhielectrode mapping time was （11.1±3.6） min. Twenty-seven types of activation sequences of AT were mapped, including 13 types of local or microreentrant AT, 1 type of small reentry AT around two lesion＂ gaps＂ of right pulmonary vein, and 13 types of macroreentry AT （ around mitral annulus 10, around the pulmonary vein and left atrial roof, 2, double reentry 1 ）. Acute successful ablation was obtained in 25 types of AT （ 89% ）. The mean procedure time was （ 122. 6±35.0 ） min, The mean exposure time was （16. 0±5.9）min. The complications related with mapping and catheter ablation were not detected. During （ 11.2±6. 6） months of follow-up, 4 cases recurred, and 2 of them could maintain sinus rhythm by taking amio-darone. Conclusions Multielectrode activation mapping using EnSite NavX/Velocity mapping system can easily and effectively achieve high density mapping of AT,which can help for the judgment of AT mechanism and the se-lection of ablation strategy, and improve the successful ablation rate in complex sustained AT after AF ablation.