CAJ | 학술논문

心房扑动是一类具有不同表现的折返性房性心律失常，包括典型心房扑动和非典型心房扑动，其中典型心房扑动是以下腔静脉-三尖瓣峡部为关键传导区域形成的折返性心律失常，而非典型心房扑动的折返环多存在于左心房或右心房且与瘢痕和慢传导区域有关。近年来，随着心脏外科手术和房颤导管消融手术例数的增加，非典型心房扑动的发病率也逐渐升高。典型心房扑动的消融通常是沿下腔静脉-三尖瓣峡部进行线性消融，而非典型心房扑动消融通常需要多种技术联合应用以明确关键传导区域的位置，这些技术包括采用三维标测系统行电解剖电压标测和激动标测及采用拖带技术确定非典型心房扑动发生的关键传导区域。本文以一例既往行房颤导管消融术后发生非典型心房扑动的患者为例，介绍我们是如何确定非典型心房扑动折返环的组成，尤其是如何发现非典型心房扑动发生的关键传导区域并予以消融成功。
심방복동시일류구유불동표현적절반성방성심률실상，포괄전형심방복동화비전형심방복동，기중전형심방복동시이하강정맥-삼첨판협부위관건전도구역형성적절반성심률실상，이비전형심방복동적절반배다존재우좌심방혹우심방차여반흔화만전도구역유관。근년래，수착심장외과수술화방전도관소융수술례수적증가，비전형심방복동적발병솔야축점승고。전형심방복동적소융통상시연하강정맥-삼첨판협부진행선성소융，이비전형심방복동소융통상수요다충기술연합응용이명학관건전도구역적위치，저사기술포괄채용삼유표측계통행전해부전압표측화격동표측급채용타대기술학정비전형심방복동발생적관건전도구역。본문이일례기왕행방전도관소융술후발생비전형심방복동적환자위례，개소아문시여하학정비전형심방복동절반배적조성，우기시여하발현비전형심방복동발생적관건전도구역병여이소융성공。
Atrial flutter is a heterogeneous group of re-entrant atrial arrhythmias including typical atrial flutter where the cavo-tricuspid isthmus is a critical zone of conduction and atypical atrial flut-ter in which the re-entrant circuit can exist in the right or left atrium associated with scar and a slow zone of conduction.The prevalence of atypical atrial flutter is increasing as the number of cardiac surgery and catheter based ablations of atrial fibrillation is more widespread.Typical atrial flutter ab-lation typically involves a linear ablation along the cavo-tricuspid isthmus as opposed to atypical atri-al flutter usually requiring an integrated approach of electroanatomical voltage mapping and activa-tion mapping in a computer based 3D mapping system as well as entrainment techniques for determi-ning critical zones of conduction.In this article we present a case of atypical atrial flutter that we have employed these tools to determine the components of an atypical atrial flutter circuit,specifically the critical zone of conduction which was targeted with radiofrequency ablation for termination of atypical atrial flutter in a patient with a prior ablation for atrial fibrillation.