CAJ | 학술논문

目的观察法洛四联症(TOF)根治术后心房扑动(房扑)的临床特点及消融长期随访结果.方法选择2004年1月至2012年5月间,因TOF根治术后并发房扑于阜外心血管病医院行射频消融治疗的11例患者,收集相关资料并进行随访.结果共11例患者入选,TOF根治术后出现房扑的时间为9～32(19.5±6.5)年,消融时的平均年龄为31 ～47(39.3±5.8)岁,术中共对15种房扑进行了标测,8例表现为单纯围绕三尖瓣环折返的房扑,5例为单纯围绕右心房瘢痕的房扑,2例为同时围绕三尖瓣环及右心房瘢痕的“8”字型折返.单纯围绕三尖瓣环折返的房扑患者与瘢痕相关性房扑患者相比,右心室较小[(27.3±2.8)mm对(38.4±10.9)mm,P=0.039].术后经过(56.7±26.7)个月的随访,有3例患者再发房扑并接受再次消融,长期成功率为72.7％.结论 TOF根治术后患者房扑的发病时间晚,瘢痕相关性房扑的比例较高,射频消融有较高的成功率.相对于单纯右心房峡部依赖性房扑,瘢痕相关性房扑患者的右心室较大.
목적 관찰법락사련증(TOF)근치술후심방복동(방복)적림상특점급소융장기수방결과.방법 선택2004년1월지2012년5월간,인TOF근치술후병발방복우부외심혈관병의원행사빈소융치료적11례환자,수집상관자료병진행수방.결과 공11례환자입선,TOF근치술후출현방복적시간위9～32(19.5±6.5)년,소융시적평균년령위31 ～47(39.3±5.8)세,술중공대15충방복진행료표측,8례표현위단순위요삼첨판배절반적방복,5례위단순위요우심방반흔적방복,2례위동시위요삼첨판배급우심방반흔적“8”자형절반.단순위요삼첨판배절반적방복환자여반흔상관성방복환자상비,우심실교소[(27.3±2.8)mm대(38.4±10.9)mm,P=0.039].술후경과(56.7±26.7)개월적수방,유3례환자재발방복병접수재차소융,장기성공솔위72.7％.결론 TOF근치술후환자방복적발병시간만,반흔상관성방복적비례교고,사빈소융유교고적성공솔.상대우단순우심방협부의뢰성방복,반흔상관성방복환자적우심실교대.
Objective To observe the clinical characters and long-term outcomes of radiofrequency catheter ablation (RFCA) for atrial flutter (AFL) in adult patients with repaired tetralogy of Fallot (TOF).Methods From January 2004 to May 2012,11 TOF patients accepted RFCA for AFL were enrolled in the study.The clinical characteristics and follow-up were collected.Results Eleven patients were enrolled.The mean age at the time of RFCA was (39.3±5.8) years (range 31-47 years).The mean time from first AFL to surgical repair of TOF was (19.5±6.5) years (range 9-32 years).During the electrophysiology study,15 AFLs were mapped:cavotricuspid (CTI)-dependent,counterclockwise atrial flutter (n =8) ; non-CTI-dependent macroreentrant scar-related AFL (n =5) ;and both CTI-and non-CTI-dependent macroreentrant AFL (n =2).Compared to CTI-dependent AFL,scar-related AFL patients were associated with larger right ventricular size[(27.3±2.8) mm vs.(38.4± 10.9) mm,P =0.039].During the follow-up [(56.7 ± 26.7) months],3 cases suffered from recurrent AFL and accepted repeat ablation.Conclusion AFL occurred later after surgical TOF repair,nearly half of them were scar-related,RFCA was effective for AFL in these patients.Compared to CTI-dependent AFL,scar-related AFL patients were associated with larger right ventricular size.