心腔内超声指导下射频消融治疗心耳起源房性心动过速

Radiofrequency ablation for atrial appendage originating atrial tachycardia with intracardial echocardiography guidance

目的:探讨心腔内超声指导下射频消融治疗心耳起源房性心动过速(房速)的有效性及安全性。方法:选取20例心耳起源房速患者,先用压力消融导管进行心腔解剖重构和激动顺序标测;提示心耳局灶起源后再用心腔内超声导管对心耳进行解剖重建,构建心耳内部分叶结构;最后用心耳局部激动顺序标测,明确定位起源,采用压力消融导管消融治疗。结果:20例患者年龄(34.3±9.7)岁,房速持续时间(23.8±22.6)个月,其中左心耳起源8例,右心耳起源12例。全部患者均成功进行心腔内超声指导下心耳的解剖重建和激动顺序标测,平均标测(45.25±6.29)点,消融导管压力(7.25±1.33)g,放电(2.85±1.31)次。最终消融成功部位:心耳基底部起源11例(55%),心耳尖端起源7例(35%),广泛起源2例(10%)。围术期未出现心包填塞、穿刺部位出血等消融并发症。随访6个月,复发3例,1例再次消融成功,2例行外科心耳切除。结论:心腔内超声指导下心耳起源房速的消融治疗有效、安全。

Aim:To evaluate the efficacy and safety of radiofrequency ablation(RFA)treating atrial appendage originating atrial tachycardia(AT)guided by intracardial echocardiography(ICE).Methods:Twenty patients with atrial appendage originating AT were enrolled in this study.Anatomic reconstruction and activation mapping of atrium were performed firstly with contact force(CF)catheter.After the diagnosis of atrial appendage originating AT was confirmed,atrial appendage structure,especially auricle lobular local region was reconstructed with ICE catheter.The atrial appendage local activation sequence was remapped and RFA was performed by CF catheter.The immediate ablation effect,long-term prognosisand perioperative complications were observed.Results:Twenty patients with age of(34.3±9.7)years and AT history of(34.3±9.7)months were studied.Among them,8 cases originated from the left atrial appendage and 12 cases originated from the right atrial appendage.The atrial appendage mapping and ablation results showed that the average point of mapping was(45.25±6.29),the pressure of ablation catheter was(7.25±1.33)g,and the discharge was(2.85±1.31)times.The final successful ablation site at the base of atrial appendage in 11 cases(55%),the tip of atrial appendage in 7 cases(35%)and wide spread atrial appendage in 2 cases(10%).There were no complications of pericardial tamponade or hemorrhage of the puncture site during perioperative period.During 6 months follow-up,3 cases experienced recurrence,among whom,1 case received successful repeated ablation,2 cases were treated with surgical atrial appendage resection.Conclusion:RFA with ICE guidance treating atrial appendage originating AT is effective and safe.