中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2012年
3期
195-200
,共6页
顾凯%居维竹%杨兵%陈红武%张凤祥%翟立上%曹克将%陈明龙
顧凱%居維竹%楊兵%陳紅武%張鳳祥%翟立上%曹剋將%陳明龍
고개%거유죽%양병%진홍무%장봉상%적립상%조극장%진명룡
心房颤动%房性心动过速%致心律失常性%消融%折返
心房顫動%房性心動過速%緻心律失常性%消融%摺返
심방전동%방성심동과속%치심률실상성%소융%절반
Atrial fibrillation%Atrial tachycardia%Proarrhythmia%Ablation%Reentry
目的 目前已知,心房内大折返是心房颤动(房颤)患者中左心房线性消融致心律失常作用的主要原因,但其局部折返的具体机制尚未明了,本文介绍左心房体部线性消融新的致心律失常作用.方法 本研究总计入选90例行左心房体部线性消融的持续性房颤患者,有11位患者[12％,男6例,平均年龄(59±11)岁]出现与之前左心房体部线性消融相关的局部折返,其中4例是在首次消融术中,其余7例是在复发房性心动过速(AT)再次消融术中.结果 所有局部折返均位于之前消融点附近,且在三维激动标测上以及拖带后的起搏后间歇反应上均显示为离心性模式.局部折返性AT的平均心动周期为(306±73)ms,靶点电图为电压较低(0.17±0.09)mV的连续复杂电位或长时双程电位,平均覆盖时限为( 142±57) ms,占心动周期的46％±12％.所有局部折返性心动过速均在导管消融后消失.结论 房颤左心房体部线性消融的致心律失常作用除传导缝隙导致的大折返外,可以表现为局部折返这一新的形式.这种局部折返在激动标测及起搏后间歇反应上均表现为离心性模式.
目的 目前已知,心房內大摺返是心房顫動(房顫)患者中左心房線性消融緻心律失常作用的主要原因,但其跼部摺返的具體機製尚未明瞭,本文介紹左心房體部線性消融新的緻心律失常作用.方法 本研究總計入選90例行左心房體部線性消融的持續性房顫患者,有11位患者[12％,男6例,平均年齡(59±11)歲]齣現與之前左心房體部線性消融相關的跼部摺返,其中4例是在首次消融術中,其餘7例是在複髮房性心動過速(AT)再次消融術中.結果 所有跼部摺返均位于之前消融點附近,且在三維激動標測上以及拖帶後的起搏後間歇反應上均顯示為離心性模式.跼部摺返性AT的平均心動週期為(306±73)ms,靶點電圖為電壓較低(0.17±0.09)mV的連續複雜電位或長時雙程電位,平均覆蓋時限為( 142±57) ms,佔心動週期的46％±12％.所有跼部摺返性心動過速均在導管消融後消失.結論 房顫左心房體部線性消融的緻心律失常作用除傳導縫隙導緻的大摺返外,可以錶現為跼部摺返這一新的形式.這種跼部摺返在激動標測及起搏後間歇反應上均錶現為離心性模式.
목적 목전이지,심방내대절반시심방전동(방전)환자중좌심방선성소융치심률실상작용적주요원인,단기국부절반적구체궤제상미명료,본문개소좌심방체부선성소융신적치심률실상작용.방법 본연구총계입선90례행좌심방체부선성소융적지속성방전환자,유11위환자[12％,남6례,평균년령(59±11)세]출현여지전좌심방체부선성소융상관적국부절반,기중4례시재수차소융술중,기여7례시재복발방성심동과속(AT)재차소융술중.결과 소유국부절반균위우지전소융점부근,차재삼유격동표측상이급타대후적기박후간헐반응상균현시위리심성모식.국부절반성AT적평균심동주기위(306±73)ms,파점전도위전압교저(0.17±0.09)mV적련속복잡전위혹장시쌍정전위,평균복개시한위( 142±57) ms,점심동주기적46％±12％.소유국부절반성심동과속균재도관소융후소실.결론 방전좌심방체부선성소융적치심률실상작용제전도봉극도치적대절반외,가이표현위국부절반저일신적형식.저충국부절반재격동표측급기박후간헐반응상균표현위리심성모식.
Objective There is a consistent understanding that the proarrhythmic effect of linear ablation in the left atrium body for atrial fibrillation (AF) always manifests as the macroreentry tachycardia.However,its genesis of localized reentry has been underestimated.Methods Among 90 persistent AF patients who had accepted linear ablation in the left atrium body,a total of 11 patients ( 12％ ) presented with a localized reentry ( six men,mean age 59 ± 11 years) associated with previous ablation lines.Among the 11 patients,four were encountered during the index procedure for AF ablation and the remaining seven during the redo procedure for atrial tachycardias (AT).Results The AT were all located at previously ablated lesion sites and manifested a centrifugal mode in both the activation mapping and pattern of the postpacing interval response.The mean tachycardia cycle length (TCL) of the localized reentrant AT was (306±73)ms.The target sites demonstrated low amplitude (0.17 ±0.09 ) mV continuous complex electrograms or long double potentials,covering ( 142 ±57 ) ms (46％ ±12％ of the TCL).The localized reentrant tachycardias were all successfully eliminated by catheter ablation.Conclusions A novel type of the proarrhythmic effects of linear ablation in the left atrium for AF may manifest as localized reentrant AT,as evidenced by the association of the site of origin with the prior lesions.
