Sra J, Bhatia A, Dhala A, Blanck Z, Rathod S, Boveja B, Deshpande S, Cooley R, Akhtar M
University of Wisconsin Medical School, St. Luke's Medical Center, Milwaukee, USA.
Pacing Clin Electrophysiol. 2000 Oct;23(10 Pt 1):1479-92. doi: 10.1046/j.1460-9592.2000.01479.x.
The accuracy of conventional techniques in localizing previous radiofrequency (RF) ablation sites and thus breakthrough sites of recurrent atrial flutter is somewhat limited. We investigated the role of electroanatomic mapping for identifying breakthrough sites or "gaps" at the tricuspid annulus and inferior vena cava (IVC)/eustachian ridge isthmus to help RF ablation in patients with recurrent typical flutter. Twelve patients (8 men, 4 women, age 63 +/- 10 years) with recurrent typical atrial flutter were included in the study. An electroanatomic mapping system (CARTO) was used to create a voltage map and activation and propagation patterns in the right atrium. Detailed voltage, activation, and propagation mapping of the tricuspid annulus and IVC/eustachian ridge isthmus allowed precise identification of gaps in all 12 patients at the tricuspid annulus (eight sites), IVC ridges (two sites), mid-isthmus region (one site), and tricuspid annulus and IVC ridges (one site). Radiofrequency energy directed at these sites eliminated atrial flutter in all 12 patients, confirmed by noninducibility of atrial flutter and demonstration of conduction block during atrial pacing on either side of the lesion lines. During a mean follow-up of 14.8 +/- 3.5 months (range 8-19 months), paroxysmal atrial flutter recurred in only one patient and was subsequently treated with amiodarone, although this had been ineffective prior to ablation. Electroanatomic mapping can precisely identify gaps in the lesion line responsible for breakthrough of recurrent typical atrial flutter at the tricuspid annulus and at the IVC/eustachian ridge isthmus. These sites can be targeted with RF ablation with a high degree of success.
传统技术在定位既往射频（RF）消融部位以及复发性心房扑动的突破部位方面的准确性存在一定局限性。我们研究了电解剖标测在识别三尖瓣环和下腔静脉（IVC）/欧氏嵴峡部的突破部位或“间隙”方面的作用，以帮助复发性典型心房扑动患者进行射频消融。本研究纳入了12例（8例男性，4例女性，年龄63±10岁）复发性典型心房扑动患者。使用电解剖标测系统（CARTO）创建右心房的电压图以及激动和传导模式。对三尖瓣环和IVC/欧氏嵴峡部进行详细的电压、激动和传导标测，使得在所有12例患者中精确识别出三尖瓣环（8个部位）、IVC嵴（2个部位）、峡部中部区域（1个部位）以及三尖瓣环和IVC嵴（1个部位）的间隙。针对这些部位施加射频能量消除了所有12例患者的心房扑动，这通过心房扑动不能诱发以及在病变线两侧心房起搏时传导阻滞的证实得以确认。在平均随访14.8±3.5个月（范围8 - 19个月）期间，仅1例患者复发阵发性心房扑动，随后接受胺碘酮治疗，尽管在消融前该治疗无效。电解剖标测能够精确识别在三尖瓣环和IVC/欧氏嵴峡部导致复发性典型心房扑动突破的病变线中的间隙。这些部位可以通过射频消融成功靶向治疗。
