房颤消融术后房性心律失常地处理和二次消融选择.ppt

房颤消融术中的左房房扑Left Atrial Flutter During Stepwise Linear Ablation of AF 中国医学科学院 阜外心血管病医院 心律失常中心 Arrhythmia Center ，Fuwai Herat Hospital Chinese Academy of Medical Sciences 姚 焰 Yan Yao 背景 Background 与房颤消融相关的左房房扑（LAFL）发生率介于2.6~31% [1]； The morbidity of AF ablation related left atrial flutter (LAFL) are 2.6~31%; 包括局灶、大折返或小折返等多种机制且多与房颤消融线的“缝隙”有关； Focal、micro- macro- reentrant mechanisms were documented and the gap on the lesions line is the sticking point of the circuit; 个体化递进式线性消融术Stepwise Linear Ablation Approach 结果 Results LAFL可在消融中由AF转化而成，或房颤消融成功之后快速刺激诱发； LAFLs were either converted from AF by ablation or induced by CIS； 34例有≥2(2~6)种的LAFL，共有146种，其中4种为局灶性，142种为大折返机制； There were 34 pts. with ≥2(2~6) LAFLs，of total 146 LAFLs， 142 were reentrant 4 were focal； 142种LAFL均与房颤消融线的缝隙有关，且均位于7字消融线上； The reentrant circuits were all related with the gaps on the Figure “7” lesions line. Case 1： 绕MVA的折返 Reentrant around the MVA 绕二尖瓣环的折返(Isochronal map of the MVA circuit) 经MVA－LIPV峡部的“缝隙”The gap on MVA-LIPV isthmus 在峡部缝隙处消融转为窦律 Termination of the LAFL Case2：经LAA-LSPV间嵴部缝隙的折返 Reentrant through the gap at LAA-LSPV ridge 等时图 Isochronal map 在嵴部消融终止了LAFLLAFL terminated during ablation at the LAA-LSPV ridge Case 3: 经左房顶部缝隙折返的LAFL Reentrant though the gap on the LA roof 等时图 Isochronal Map 在顶部缝隙处消融终止了LAFLLAFL termination during ablation on the gap 与左房房扑折返环相关的缝隙分布The distribution of the LAFL related gaps 7字消融线的多个缝隙Multiple Gaps on the Figure “7” lesion line 顶部的缝隙 Gap on LA Roof 嵴部的缝隙 Gap at LAA-LSPV Ridge MVA的缝隙 Gap at LIPV-MVA Isthmus 最终消融成功部位 Final Target 消融效果 Ablation Results 能量:功率60W，温度58℃，每次60-90s； 平均放电 4 ± 2.1 次； 即时成功率(消融终止+不再诱发): LSPV-LAA间嵴部：60/68 (88.2%)； 左房顶部：44/50 (88%)； LIPV-MVA峡部：22/24 (92%)； 随访 Follow up 平均( 11 ± 6.7) 月： 维持窦律 (sinus rhythm): 62/80(77.5%)； 短阵房速 (focal AT): 12/80(15%)； 左房房扑 (LAFL): 6/80 (7.5)； 新发现 New Findings 缝隙的分布：既往研究中经二尖瓣环峡部缝隙的折返多见，本研究中经LAA－LSPV间嵴部及左房顶部缝隙的折返更多见； Gaps on LAA-LSPV ridge roof were more common in t