CAJ | 학술논문

目的总结经右心房游离壁切口术后双环折返性房性心动过速(房速)的发生率及射频消融后长期随访的结果.方法 2007年1月至2012年12月共入选48例在南京医科大学第一附属医院心脏科行经右心房游离壁切口治疗先天性心脏病或获得性心脏病后发作房速的患者.双环折返性房速的定义为心房同时存在两个折返环,同时在折返的可能路径上进行多部位拖带均为隐匿性.结果共观察到8例患者术中存在双环折返性房速,男4例,平均年龄(40.4±22.0)岁.第1次外科术后至房速发作时间为(79.0±65.2)个月,第1次房速发作至第1次消融的时间为(20.8±28.3)个月,所有患者房速均持续发作.所有患者的双环折返性房速均与三尖瓣峡部以及右心房游离壁切口相关.5例患者在消融三尖瓣峡部过程中,心动周期突然变化;1例患者消融三尖瓣峡部时,心动周期无变化,右心房游离壁多部位拖带为右心房游离壁折返性房速,间隔部位拖带证实此部位不在折返环内,可能提示右心房游离壁折返性房速为主导折返环,;1例患者消融过程中心动过速终止,同样行切口致下腔的线性消融;1例患者消融三尖瓣峡部时心动过速无明显变化,但冠状静脉窦的激动有细微变化,拖带标测提示三尖瓣峡部不在折返环内,右心房游离壁多部位拖带提示为围绕右心房切口瘢痕折返的心动过速,行外科切口下部至下腔静脉消融时,房速终止.平均随访(33.6±16.7)个月,3例复发患者均为风湿性心脏病换瓣术后,其中1例复发房速,另外2例复发房颤.结论经右心房游离壁切口术后双环折返性房速主要与三尖瓣峡部以及切口相关,三尖瓣峡部以及切口至下腔静脉线性消融常能够治疗这类心律失常.
목적 총결경우심방유리벽절구술후쌍배절반성방성심동과속(방속)적발생솔급사빈소융후장기수방적결과.방법 2007년1월지2012년12월공입선48례재남경의과대학제일부속의원심장과행경우심방유리벽절구치료선천성심장병혹획득성심장병후발작방속적환자.쌍배절반성방속적정의위심방동시존재량개절반배,동시재절반적가능로경상진행다부위타대균위은닉성.결과 공관찰도8례환자술중존재쌍배절반성방속,남4례,평균년령(40.4±22.0)세.제1차외과술후지방속발작시간위(79.0±65.2)개월,제1차방속발작지제1차소융적시간위(20.8±28.3)개월,소유환자방속균지속발작.소유환자적쌍배절반성방속균여삼첨판협부이급우심방유리벽절구상관.5례환자재소융삼첨판협부과정중,심동주기돌연변화;1례환자소융삼첨판협부시,심동주기무변화,우심방유리벽다부위타대위우심방유리벽절반성방속,간격부위타대증실차부위불재절반배내,가능제시우심방유리벽절반성방속위주도절반배,;1례환자소융과정중심동과속종지,동양행절구치하강적선성소융;1례환자소융삼첨판협부시심동과속무명현변화,단관상정맥두적격동유세미변화,타대표측제시삼첨판협부불재절반배내,우심방유리벽다부위타대제시위위요우심방절구반흔절반적심동과속,행외과절구하부지하강정맥소융시,방속종지.평균수방(33.6±16.7)개월,3례복발환자균위풍습성심장병환판술후,기중1례복발방속,령외2례복발방전.결론 경우심방유리벽절구술후쌍배절반성방속주요여삼첨판협부이급절구상관,삼첨판협부이급절구지하강정맥선성소융상능구치료저류심률실상.
Objective The purpose of the study was to demonstrate the prevalence and to define the optimal mapping and ablation strategy of atrial tachycardia (AT) after an incision of the right atrial free wall.Methods Forty-eight consecutive patients with AT after an incision of the right atrial free wall to the treatment of congenital heart disease or acquired heart disease.Dual-loop atrial tachycardia was defined as the presence of two simultaneous circuits,entrainment of tachycardia from several site around the atriotomy scar and septum demonstrated PPI ≤ (tachycardia cycle length +20 ms).Results Dual-loop AT was demonstrated in eight patients(4 men,mean age 40.4±22.0 years).The mean interval between the occurrence of symptomatic AT and the surgical intervention was(79.0±65.2) months.The initial procedure was performed(20.8±28.3)months after first onset of AT.Dual-loop included an isthmus-dependant atrial flutter combined with the reentry around the incisional scar.Abrupt change sequence of coronary sinus activation was observed in five patients during radiofrequency ablation at cavotricuspid isthmus,while one with no change; and one patient with the termination of tachycardia.All tachycardia were terminated during creation of a ablation line connecting the incision of right free wall and inferior vena cava.After a mean follow-up of(33.6±16.7)months,two and one of the patients with rheumatic heart disease had AT recurrence and the development of atrial fibrillation,respectively.Conclusion Dual-loop atrial tachycardias after heart surgery were related to the incision of right free wall and cavotricuspid isthmus,radiofrequency ablation of the two distinct isthmuses is effective to cure the arrhythmia.