40例局灶性房性心动过速的射频消融治疗

Radiofrequency catheter ablation for focal atrial tachycardia in forty cases

目的总结本院射频消融治疗局灶性房性心动过速(简称房速)的消融点、方法及疗效。方法分析5年间40例行射频消融治疗的房速患者的临床资料,探究消融靶点的分布、消融术的成功率和特殊起源点的消融方法,随访复发情况。结果 1起源于右房的房速多于左房(60%vs 40%)。右房常见消融点依次为右房间隔、界嵴、三尖瓣环、冠状窦口、上腔静脉和右心耳。左房常见消融点依次为肺静脉、左房间隔和左心耳。2射频消融治疗的成功率为85%(34/40)。85%的患者在En Site 3000三维标测指引下消融。3起源于右房间隔His束旁的6例房速通过无冠窦消融成功治愈4例,另2例于His束周围低功率消融失败。结论三维标测系统指引下行射频消融治疗局灶性房速效果肯定。His束旁起源的房速可通过主动脉无冠窦内消融。

Objective To investigate the effect of radiofrequency catheter ablation in patients with focal atrial tachycardia. Method The clinical data of forty patients who received catheter ablation because of focal atrial tachycardia were collected. Explored the distributions of the ablation targets, the success rate of the ablation and the ablation methods of focal atrial tachyeardias originating from special sites. The recurrence were followed up. Result （1）More focal atrial tachycardia originated from the right atrium than the left atrium （ 60% vs 40% ）. In the fight atrium commom locations of catheter ablation were successively the right-side of the interatrial septum, the crista terminalis, tricuspid annulus, coronary sinus ostium, the superior vena eava and right atrial appendage. In the left atrium common locations of catheter ablation were successively the pulmonary vein ostium, the left-side of the interatrial septum and the left atrial appendage. （2）Eighty-five percent of the patients received catheter ablation guided by EnSite 3000. The success rate of the treatment was eighty-five percent （34/40）. （3）Among six cases with tachyeardia originating from the location near the His bundle in the right-side of the interatrial s eptum four cases were cured after ablation in the non-coronary aortic sinus. The other two cases received failed ablation with low power near the His bundle. Conclusion Radiofrequeney catheter ablation guided by three dimensional mapping system is an effective treatment for focal atrial tachycardia. Ablation in the non-coronary aortic sinus can cure atrial tachycardia originating from the lacation near the His bundle. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2015,29 （6） ：522-525]