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
6期
424-430
,共7页
詹贤章%薛玉梅%吴书林%杨平珍%方咸宏%廖洪涛%梁远红%魏薇%邓海%张黔桓%蒙霏霭
詹賢章%薛玉梅%吳書林%楊平珍%方鹹宏%廖洪濤%樑遠紅%魏薇%鄧海%張黔桓%矇霏靄
첨현장%설옥매%오서림%양평진%방함굉%료홍도%량원홍%위미%산해%장검환%몽비애
心房颤动%房性心动过速%多极标测%射频导管消融
心房顫動%房性心動過速%多極標測%射頻導管消融
심방전동%방성심동과속%다겁표측%사빈도관소융
Atrial fibrillation%Atrial tachycardia%Multielectrode activation mapping%Radiofrequency catheter ablation
目的 报道EnSite NavX/Velocity系统的多极标测功能在心房颤动(房颤)消融术后持续性房性心动过速(房速)中的应用体会.方法 18例房颤消融术后并发持续性房速患者,平均年龄(54.5±12.8)岁,男12例,女6例.心动过速均呈持续性发作,于心房进行多极标测,建立激动图；根据激动图,结合传导图、电压图,对房速机制进行判断,制定消融策略；对于折返性房速,线性消融关键峡部或传导通道(channel),对于局灶性房速,点消融局部最早心房激动区域.结果 18例患者中,每例并发1／4种房速,共28种房速行多极标测,周长为(260.7±57.6)ms,平均取点(368.6±152.4)个,标测时间(11.1±3.6) min,共建立27种激动图.激动图显示局灶性或微折返性房速13种；小折返性房速1种(围绕右侧肺静脉2个损伤性“漏点”形成的折返)；大折返性房速13种:围绕二尖瓣环10种,围绕肺静脉经过左心房顶壁形成单环折返2种、双环折返1种.28种房速中,25种即时消融成功,成功率89％；无标测及消融相关并发症发生.手术时间为(122.6±35.0)min,曝光时间为(16.0±5.9) min.随访(11.2±6.6)个月,18例患者中,4例复发,2例服用胺碘酮可维持窦性心律.结论 应用EnSite NavX/Velocity系统的多极标测功能,易达到高密度标测效果,有助于房速机制的快速判断及消融策略的制定,可提高房颤术后持续性房速的消融成功率.
目的 報道EnSite NavX/Velocity繫統的多極標測功能在心房顫動(房顫)消融術後持續性房性心動過速(房速)中的應用體會.方法 18例房顫消融術後併髮持續性房速患者,平均年齡(54.5±12.8)歲,男12例,女6例.心動過速均呈持續性髮作,于心房進行多極標測,建立激動圖；根據激動圖,結閤傳導圖、電壓圖,對房速機製進行判斷,製定消融策略；對于摺返性房速,線性消融關鍵峽部或傳導通道(channel),對于跼竈性房速,點消融跼部最早心房激動區域.結果 18例患者中,每例併髮1／4種房速,共28種房速行多極標測,週長為(260.7±57.6)ms,平均取點(368.6±152.4)箇,標測時間(11.1±3.6) min,共建立27種激動圖.激動圖顯示跼竈性或微摺返性房速13種；小摺返性房速1種(圍繞右側肺靜脈2箇損傷性“漏點”形成的摺返)；大摺返性房速13種:圍繞二尖瓣環10種,圍繞肺靜脈經過左心房頂壁形成單環摺返2種、雙環摺返1種.28種房速中,25種即時消融成功,成功率89％；無標測及消融相關併髮癥髮生.手術時間為(122.6±35.0)min,曝光時間為(16.0±5.9) min.隨訪(11.2±6.6)箇月,18例患者中,4例複髮,2例服用胺碘酮可維持竇性心律.結論 應用EnSite NavX/Velocity繫統的多極標測功能,易達到高密度標測效果,有助于房速機製的快速判斷及消融策略的製定,可提高房顫術後持續性房速的消融成功率.
목적 보도EnSite NavX/Velocity계통적다겁표측공능재심방전동(방전)소융술후지속성방성심동과속(방속)중적응용체회.방법 18례방전소융술후병발지속성방속환자,평균년령(54.5±12.8)세,남12례,녀6례.심동과속균정지속성발작,우심방진행다겁표측,건립격동도；근거격동도,결합전도도、전압도,대방속궤제진행판단,제정소융책략；대우절반성방속,선성소융관건협부혹전도통도(channel),대우국조성방속,점소융국부최조심방격동구역.결과 18례환자중,매례병발1／4충방속,공28충방속행다겁표측,주장위(260.7±57.6)ms,평균취점(368.6±152.4)개,표측시간(11.1±3.6) min,공건립27충격동도.격동도현시국조성혹미절반성방속13충；소절반성방속1충(위요우측폐정맥2개손상성“루점”형성적절반)；대절반성방속13충:위요이첨판배10충,위요폐정맥경과좌심방정벽형성단배절반2충、쌍배절반1충.28충방속중,25충즉시소융성공,성공솔89％；무표측급소융상관병발증발생.수술시간위(122.6±35.0)min,폭광시간위(16.0±5.9) min.수방(11.2±6.6)개월,18례환자중,4례복발,2례복용알전동가유지두성심률.결론 응용EnSite NavX/Velocity계통적다겁표측공능,역체도고밀도표측효과,유조우방속궤제적쾌속판단급소융책략적제정,가제고방전술후지속성방속적소융성공솔.
Objective To explore the application of multielectrode activation mapping by EnSite NavX/Velocity mapping system in sustained atrial tachycardia (AT) after atrial fibrillation (AF) ablation.Methods Eighteen patients with sustained AT after AF ablation in our hospital were retrospectively analyzed.Among the 18 pts,the mean age was (54.5 ± 12.8)years (male 12 pts,female 6 pts).All patients were guided by multielectrode activation mapping by NavX/Velocity mapping system.The activation sequences of AT were mapped.Radiofrequency catheter ablation was performed at the critical reentry isthmus or the focal origin by constructing three-dimensional model of atrium.Results Twenty-eight types of AT were presented in 18 patients.The average cycle lengths of AT were (260.7±57.6)ms.The mean multielectrode mapping points were (368.6± 152.4).The mean multielectrode mapping time was (11.1 ±3.6)min.Twenty-seven types of activation sequences of AT were mapped,including 13 types of local or microreentrant AT,1 type of small reentry AT around tWo lesion" gaps" of right pulmonary vein,and 13 types of macroreentry AT (around mitral annulus 10,around the pulmonary vein and left atrial roof,2,double reentry 1).Acute successful ablation was obtained in 25 types of AT(89％).The mean procedure time was (122.6±35.0)min,The mean exposure time was (16.0±5.9) min.The complications related with mapping and catheter ablation were not detected.During (11.2±6.6) months of follow-up,4 cases recurred,and 2 of them could maintain sinus rhythm by taking amiodarone.Conclusions Multielectrode activation mapping using EnSite NavX/Velocity mapping system can easily and effectively achieve high density mapping of AT,which can help for the judgment of AT mechanism and the selection of ablation strategy,and improve the successful ablation rate in complex sustained AT after AF ablation.
