CAJ | 학술논문

目的探讨慢性心房颤动(房颤)环肺静脉消融术后房性心动过速(房速)的机制及射频消融的方法.方法慢性房颤消融术后房速患者9例,均为男性,年龄50～70(62.6±7.2)岁.在三维标测系统和环状标测导管联合指导下,对无心房-肺静脉电传导者的房速经标测在关键峡部消融;对存在心房一肺静脉电传导者的房速,在原消融径线上的裂隙处消融.结果 3例为无心房-肺静脉点传导的折返性房速,于关键峡部线性消融后房速终止;6例为存在心房-肺静脉电传导的房速,对原消融径线裂隙消融后,4例房速终止,余2例附加左心房峡部线性消融后房速亦终止.消融术时间为90～295(211.7±75.4)min,X线曝光时间为11.5～67.6(25.5±16.5)min.消融术后各种刺激亦均不能诱发房速,没有出现肺静脉狭窄和其他相关并发症.随访4～8(6.2±1.4)个月,9例患者停用抗心律失常药物后仍为窦性心律.结论慢性房颤消融术后恢复心房-肺静脉电传导的房速(66.7%)占大多数;无心房-肺静脉电传导的房速多为折返机制;针对恢复传导部位的补点式消融和对折返环关键峡部的线性消融,可以成功终止并发的房速.
목적 탐토만성심방전동(방전)배폐정맥소융술후방성심동과속(방속)적궤제급사빈소융적방법.방법 만성방전소융술후방속환자9례,균위남성,년령50～70(62.6±7.2)세.재삼유표측계통화배상표측도관연합지도하,대무심방-폐정맥전전도자적방속경표측재관건협부소융;대존재심방일폐정맥전전도자적방속,재원소융경선상적렬극처소융.결과 3례위무심방-폐정맥점전도적절반성방속,우관건협부선성소융후방속종지;6례위존재심방-폐정맥전전도적방속,대원소융경선렬극소융후,4례방속종지,여2례부가좌심방협부선성소융후방속역종지.소융술시간위90～295(211.7±75.4)min,X선폭광시간위11.5～67.6(25.5±16.5)min.소융술후각충자격역균불능유발방속,몰유출현폐정맥협착화기타상관병발증.수방4～8(6.2±1.4)개월,9례환자정용항심률실상약물후잉위두성심률.결론 만성방전소융술후회복심방-폐정맥전전도적방속(66.7%)점대다수;무심방-폐정맥전전도적방속다위절반궤제;침대회복전도부위적보점식소융화대절반배관건협부적선성소융,가이성공종지병발적방속.
Objective To evaluate the radiofrequency(RF)ablation for the recurrent atrial tachycar-dia(AT)originated from left atrium(LA)after continuous circdar lesions(CCLs)around the ipsilateral pul-monary veins(PVs)in patients with chronic atrial fibrillation(AF).Methods A repeat procedure was per-formed in 9 patients[9 males;age 50～70(62.6±7.2)]with recurrent AT.In this procedure,LA-PV con-duction was confirmed by Lasso catheter.If no LV-PV conduction,activation mapping and entrainment tech-nique were performed with 3-D Carto system to identify the earliest activation area and reentrant cireuit. If LV-PV conduction recovered,the gap on the original CCLs was confirmed and was blocked again.Results No LA-PV conduction in the 3 patients and LA-PV conduction in 6 patients were demonstrated.In the 3 patients with-out LA-PV conduction,reentrant AT was confirmed and was successfuUy abolished by blocking the reentrant cir-cult.In the other 6 patients with LA-PV conduction,all conduction gaps were successfully closed with segmental RF ablation.Recurrent AT was successfully terminated in 4 patients and changed to macroreentrant AT in the other 2 patients.Following blocked the LA isthmus to terminate remained AT.The duration of the procedure was 90～295(211.7±75.4)min and the duration of X-ray was11.5～67.6(25.5 ±16.5)min.During follow-up of 4～8(6.2±1.4)months,all 9 patients were free of AT without antiarrhythmic drugs.Conclusions In pa-tients with recurrent AT after CCLs for chronic AF,AT without recovered LA-PV is complicated and can be abolished by mapping and ablation of reentrant circuit;AT with recovered LA-PV conduction(66.7%)is a dominant finding and can be successfully eliminated by segmental RF ablation.