Medeiros A, Iturralde P, Guevara-Valdivia M E, Ramírez S, Rodríguez L, Rodríguez I, Mendoza C, Colín L
Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, 14080, México D.F.
Arch Cardiol Mex. 2001 Jul-Sep;71(3):221-6.
Atrial flutter is one of the most common arrhythmias in patients with atrial septal defect, after surgery 14% of patients can develop it and may be associated with high morbidity. In this study we performed prophylactic and therapeutic ablation of atrial flutter during atrial septal closure surgery drawing 4 lines; line 1, isthmus cavo-tricuspid, the area between the inferior vena cava and the tricuspid ring; line 2, the area between coronary sinus ostium and inferior vena cava; line 3, the area between tricuspid valve annulus and coronary sinus ostium; and line 4, the area between lateral atriotomy and atrial septal defect. Twenty-one patients were included, 6 (28.5%) patients had atrial flutter before surgery and 15 (71.4%) were in sinus rhythm. There were no new cases of atrial flutter, but at six months follow up 2 (33.3%) patients recidivated with atrial flutter. One patient developed high degree atrio-ventricular block and a pacemaker had to be implanted. Older age at the time of surgery and high systolic pulmonary pressure were significantly higher in those patients with atrial flutter before surgery and in patients with arrhythmias recurrence. Ablation of atrial flutter during atrial septal closure surgery can be a good option for the treatment and prevention of atrial arrhythmias, but more studies are still needed.
心房扑动是房间隔缺损患者中最常见的心律失常之一，术后14%的患者可能会发生，且可能与高发病率相关。在本研究中，我们在房间隔封堵手术期间对心房扑动进行了预防性和治疗性消融，绘制了4条线；线1，腔静脉-三尖瓣峡部，即下腔静脉与三尖瓣环之间的区域；线2，冠状窦口与下腔静脉之间的区域；线3，三尖瓣环与冠状窦口之间的区域；线4，外侧心房切开术与房间隔缺损之间的区域。纳入21例患者，6例（28.5%）患者术前有心房扑动，15例（71.4%）为窦性心律。没有新的心房扑动病例，但在6个月的随访中，2例（33.3%）患者复发心房扑动。1例患者发生高度房室传导阻滞，不得不植入起搏器。术前有心房扑动的患者以及有心律失常复发的患者在手术时年龄较大且收缩期肺动脉压明显较高。在房间隔封堵手术期间消融心房扑动可能是治疗和预防房性心律失常的一个好选择，但仍需要更多的研究。
