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目的探讨三维标测系统指导下大折返性房性心动过速(macroreentry 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。合并右房明显扩大12例。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和/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①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。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。②7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。③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。
Objective To investigate the electrophysiological characteristics and ablation effect of macroresentrial atrial tachycardia (MAT) guided by three-dimensional mapping system. Methods From August 2009 to September 2011, 38 cases of MAT confirmed by electrophysiological examination were undergone, with a mean age of (48.4 ± 10.8) years. There were 17 males and 21 females, and 15 of 38 were persistent or non-stop heart beats Too fast. Consolidation of the right atrium significantly expanded in 12 cases. Routine electrophysiological examination to determine the origin of the heart rate of atrial tachycardia, CARTO three-dimensional mapping system under the guidance of three-dimensional electrical stimulation and / or voltage mapping to determine the MAT key isthmus and its matrix, cold saline irrigation catheter corresponding linear ablation or Focal ablation. Results ① There were 31 cases of right atrium MAT, 27 cases had no history of surgery and ablation, 54.8% (17/31) had single reentry loop MAT, and 45.2% (14/31) combined with other types of tachycardia. 31 cases of MAT were performed tricuspid isthmus ablation, 30 cases of isthmic ablation antrum was terminated. 16 cases of simple ablation isthmus reached the end of ablation, the other 14 cases at the same time other parts of the ablation. Seven cases of left atrial MAT were treated with catheter ablation. Four of them had GAP in the original ablation line, and three were mitral isthmus-dependent atrial flutter. 6 cases of successful ablation. ③ The success rate of ablation in this group was 94.7% (36/38). The follow-up time ranged from 2 to 36 (18.6 ± 4.5) months, with 7 recurrent cases (relapse rate of 19.4% (7/36)]. Five patients were successfully ablated again. No symptoms were observed in 89.5% (34/38) of the patients during follow-up. CONCLUSIONS: Right atrium MAT is often associated with tricuspid isthmus and spontaneous scarring. MAT in the left atrium is associated with surgical injury. Three-dimensional mapping may help to improve the success rate of ablation of complicated arrhythmia.