CARTO标测指导下大折返性房速的导管消融疗效 - 第三军医大学学报.DOC

CARTO标测指导大折返性房性心动过速导管消融临床疗效分析 舒茂琴，冉擘力，钟 理，宋治远，朱 平，周 扬，李永华，李华康 （400038重庆，第三军医大学西南医院心血管内科，重庆市介入心脏病学研究所[摘要] 目的 探讨三维标测系统指导下大折返性房性心动过速(marcroreentry atrial tachycardia,MAT)电生理特征和消融效果。方法 2009年8月至2011年9月本科电生理检查确诊的MAT共计38例，年龄（48.4±10.8）岁，男性17例，女性21例，38例中15例为持续性或无休止性心动过速，12例右房明显扩大。。常规电生理检查初步确定房速的起源心腔，在CARTO三维标测系统指导下行三维电激动/或电压标测，确定MAT关键峡部及其基质，用冷盐水灌注导管行相应的线性消融或局灶性消融。结果 右房MAT共31例，27例无外科手术及消融术病史，54.8％（17/31）为单个折返环MAT，45.2％（14/31）合并其他类型心动过速。所有31例MAT均行三尖瓣峡部消融，30例消融峡部房扑终止。16例单纯消融峡部达到消融终点，另14例则同时行其他部位消融。7例左房MAT均为导管消融术后患者，其中4例在原有的消融线上存在传导裂隙（GAP），3例为二尖瓣峡部依赖性房扑。6例消融成功。本组消融成功率为94.7％（36/38）。随访时间2～36（18.6±4.5）个月，7例复发[复发率19.4％，（7/36）]，5例再次消融成功，随访期间89.5％（34/38）的患者无房速发作。结论 右房MAT常与三尖瓣峡部和自发性瘢痕有关，而左房MAT多与手术损伤有关，三维标测有助于提高复杂心律失常的消融成功率。 [关键词] 心动过速, 折返性电生理学技术, 心脏[中图法分类号] [文献标志码] A Clinical results of catheter ablation guided by CARTO three-dimensional mapping system in 38 patients with marcroreentry atrial tachycardia Shu Maoqin，Ran Boli，Zhong Li，Song Zhiyuan，Zhu Ping, Zhou Yang，Li Yonghua，Li Huakang (Department of Cardiology，Southwest Hospital，Third Military Medical University，Chongqing400038，China) [Abstract] Objective To explore the clinical value of the electroanatomical CARTO mapping system in the guiding of radiofrequency ablation of marcroreentry atrial tachycardia (MAT). Methods Totally 38 MAT patients, received the therapy from August 2009 to September 20011 in our hospital were studied. Conventional electrophysiological study was performed to determine the location of MAT before the three dimensional electroanatomic mapping. Using voltage and activation maps guided by CARTO mapping system, the mechanism of tachycardia was analyzed and the slow conduction areas (critical isthmus) were verified. Radiofrequency energy was delivered using irrigated-tip catheter. Results ①There were 17 males and 21 females at the age of (48. 4 ± 10. 8), 15 patients has persistent/or permanent tachycardia, and 12 patients had right atrial enlargement among the