二尖瓣置换术同期行心房颤动射频消融术后房性心动过速的射频消融术治疗

Radiofrequency Catheter Ablation for Atrial Tachycardia in Patients after Radiofrequency Ablation of Atrial Fibrillation during Mitral Valve Replacement

目的随访风湿性心脏病患者行二尖瓣置换术同期行心房颤动射频消融术后的心律,探索发生房性心动过速(房速)患者的导管射频消融效果。方法纳入因风湿性心脏病行二尖瓣置换术同期行心房颤动外科消融术后发生房速的11例患者,在心动过速持续状态下采用三维电解剖标测系统,建立左心房或右心房标测图,根据标测结果选择心动过速的关键部位行射频消融术。男4例、女7例,平均年龄(49±8)岁。结果该组患者行外科手术时间为(149±18)min,术后住院时间(9.5±2.9)d,住ICU时间(1.8±0.4)d。在电解剖标测过程中,11例患者共标测出17种心动过速,其中5例患者(6例次,35%)起源于右心房,6例患者(11例次,65%)起源于左心房,其中2例与二尖瓣环有关。消融术中即时成功率为91%(10/11)。平均随访(17±4)个月后,2例左心房房速患者复发。结论该类患者发生的房速来自左心房居多,大多数非二尖瓣瓣环依赖,行导管射频消融术效果满意且安全。

Objective To investigate heart rhythm outcomes of radiofrequency ablation （RFA） of atrial fibrillation （AF） during mitral valve replacement （MVR） for patients with rheumatic heart disease （RHD）, and explore clinical results of radiofrequency catheter ablation （RFCA） for postoperative atrial tachycardia （AT）. Methods Eleven RHD patients who developed AT after RFA of AF during MVR were enrolled in this study. There were 4 males and 7 females with their age of 49±8 years. Electroanatomic mapping of the left or right atrium was conducted with three-dimensional electroanatomic mapping system during continuous AT. RFCA was performed at the key areas of AT. Results For MVR, operation time was 149±18 minutes, postoperative hospital stay was 9.5 ±2.9 days, and length of ICU stay was 1.8±0.4 days. During electroanatomic mapping, 17 ATs were recorded in 11 patients. Six ATs （35%） of 5 patients originated from the right atrium and 11 ATs （65%） of 6 patients originated from the left atrium （LA）. Among them, AT of 2 patients was related to the mitral valve ring. Immediate success of RFCA was obtained in 91% （ 10/11 ）. After a mean follow-up of 17 ± 4 months, 2 patients whose AT originated from LA had AT recurrence. Conclusions Majority of postoperative ATs originate from LA, and majority of ATs are not mitral-dependent. RFCA is an effective and safe procedure for AT in patients after RFA of AF during MVR.