射频消融心房扑动拖带刺激的电生理特征

Electrophysiologic Characters of Entrainment in Patients with Atrial Flutter During Radiofrequency Catheter Ablation.

探讨射频消融心房扑动 (简称房扑 )拖带刺激的电生理特征 ,更好的理解房扑机制 ,以期提高消融成功率、减少复发率。 5例阵发性典型房扑患者 ,诱发房扑后 ,在高位、低位右房 ,冠状窦口 (CSO)及右房下部的峡部分别进行拖带刺激 ,分析心房激动顺序 ,然后进行三尖瓣环至下腔静脉之间的线性消融。 5例房扑折返环均为逆钟向旋转 ,峡部 ,高位、低位右房及CSO呈现隐匿拖带 ,左房和卵圆窝呈现显性拖带 ,平均放电 9± 6次 ,均达到右房峡部双向阻滞。CSO起搏时体表心电图Ⅱ、Ⅲ、aVF导联P波形态发生改变。结论 :隐匿、显性拖带对判断峡部依赖性逆钟向房扑有较高价值 。

determine the evaluation of electrophysiologic charaters of entrainment pacing in understanding atrial flutter mechanism raising successful rate,reducing recurrence rate.Methods:Entrainment pacing was performed in the patients with typical atrial flutter in high right atrium,ostium of coronary sinus,isthmus between inferior vena cava (IVC) and tricuspid valve annulus (TVA) after inducing atrial flutter.Activation sequence was analyzed,then ablation line was done at isthmus between IVC and TVA.Results:Reentry with counter clockwise in right atrium and concealed entrainment were found in isthmus between IVC and TVA,high right atrium,lower right atrium,and ostium of coronary sinus.Overt entrainment was found in left atrium and fossa ovalis (FO) during entrainment pacing.Complete block in isthmus between IVC and TVA was achieved after 9±6 delivery of radiofrequency (RF) energy.P waves morphology changed in lead Ⅱ,Ⅲ and aVF of ECG during pacing ostium of coronary sinus.Conclusions:Concealed and overt entrainment are useful for evalution of isthmus dependence of atrial flutter.Changes of activation sequence of intracardic electrogram and P wave morphology during pacing ostium of coronary sinus are a marker of complete block of isthmus during RF ablation of atrial flutter.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(3):177～179]