CAJ | 학술논문

目的：探讨先天性心脏病外科修补术后三尖瓣峡部依赖型心房扑动，手术瘢痕区消融的必要性，是否存在形成心动过速的折返基质，评价消融的疗效。方法2010年1月至2013年12月共入选48例在徐州市中心医院心脏科行经右心房游离壁切口治疗先天性心脏病后发作心房扑动的患者，其中单纯三尖瓣峡部依赖型心房扑动为31例，在这31例患者三尖瓣峡部双向阻滞后，在窦律下行右心房基质标测，确定瘢痕区域并局部高密度标测。在冠状窦近端刺激下，标测瘢痕是否存在“Channel”和缓慢传导区，有局部形成折返基质，来决定是否消融瘢痕区至腔静脉。结果11例标测过程中低电压区内可标测到1～5（2.6±1.2）个双电位线（LDPs）和（或）电静止区（ESAs），且大多数LDPs和ESAs在房性心动过速终止后的窦性心律下仍可见到。在此区域内可记录到低幅、长时限碎裂电位，平均振幅（0.21±0.05）mV，平均时限（123±14）ms，占心动过速周长（43±5）%。窦律下起搏冠状窦近端提示瘢痕线未形成传导阻滞，存在潜在形成折返基质，消融瘢痕至腔静脉。20例提示瘢痕已形成解剖屏障，未消融瘢痕区域。随访（36±12）个月，2例患者复发，均为心房颤动合并左心房心房扑动。结论经右心房切口术后三尖瓣峡部依赖型心房扑动，在三尖瓣峡部双向阻滞后，有必要在窦律下行右心房基质标测和起搏标测，评价瘢痕能否会形成潜在心动过速通道，减少不必要的消融。
목적：탐토선천성심장병외과수보술후삼첨판협부의뢰형심방복동，수술반흔구소융적필요성，시부존재형성심동과속적절반기질，평개소융적료효。방법2010년1월지2013년12월공입선48례재서주시중심의원심장과행경우심방유리벽절구치료선천성심장병후발작심방복동적환자，기중단순삼첨판협부의뢰형심방복동위31례，재저31례환자삼첨판협부쌍향조체후，재두률하행우심방기질표측，학정반흔구역병국부고밀도표측。재관상두근단자격하，표측반흔시부존재“Channel”화완만전도구，유국부형성절반기질，래결정시부소융반흔구지강정맥。결과11례표측과정중저전압구내가표측도1～5（2.6±1.2）개쌍전위선（LDPs）화（혹）전정지구（ESAs），차대다수LDPs화ESAs재방성심동과속종지후적두성심률하잉가견도。재차구역내가기록도저폭、장시한쇄렬전위，평균진폭（0.21±0.05）mV，평균시한（123±14）ms，점심동과속주장（43±5）%。두률하기박관상두근단제시반흔선미형성전도조체，존재잠재형성절반기질，소융반흔지강정맥。20례제시반흔이형성해부병장，미소융반흔구역。수방（36±12）개월，2례환자복발，균위심방전동합병좌심방심방복동。결론경우심방절구술후삼첨판협부의뢰형심방복동，재삼첨판협부쌍향조체후，유필요재두률하행우심방기질표측화기박표측，평개반흔능부회형성잠재심동과속통도，감소불필요적소융。
Objective The purpose of this study was to explore the necessity of ablating SCAR with tricuspid isthmus-dependent atrial flutter in congenital heart disease after surgical repaired, and evaluate the effect of ablation. Methods Forty-eight consecutive patients with AT after an incision of the right atrial free wall to the treatment of congenital heart disease were colleced. 31 AFLs were merely CTI-depended AFL and were all treated with CTI ablation successfully, in sinus rhythm, the mapping of substrates in the right atrial, and local high density mapping in SCAR was determined. Under the coronary sinus proximal stimulation, mapping the existence of scar‘channel’ and slow conduction zone, there was potential for forming the tachycardia substrates, determine whether ablation scar to vena cava. Results In 11 patients, the reentry circuits were located within a large low voltage (bipolar votage≤0.5 mV) area in different parts of right atrium, which contained, electrically silent areas (ESAs) and/or line of double potentials (LDPs). In the isthmus of the circuits, low amplitude (0.21±0.05)mV, long duration (123±14)msfractionated electrogram were found, which accounting for (43±5)%of the TCL. 11 cases were ablated the scar from the vena to cava. 20 cases indicated that the scar had formed the anatomic barrier, had no ablated. All of the cases were followed up about (36±12)months, 2 patients recurred, and were complicated with left atrial atrial fibrillation and atrial flutter. Conclusion Tricuspid isthmus dependent atrial flutter was in congenital heart disease after surgical repair. After the tricuspid isthmus was blocked, it is necessary about the mapping of substrates in the right atrial, and local high density mapping in SCAR was determined, to assess potential tachycardia of the SCAR, and reduce unnecessary ablation.