Molenschot M, Ramanna H, Hoorntje T, Wittkampf F, Hauer R, Derksen R, Sreeram N
Heart-Lung Institute, Academic Medical Center Utrecht, The Netherlands.
Pacing Clin Electrophysiol. 2001 Nov;24(11):1616-22. doi: 10.1046/j.1460-9592.2001.01616.x.
Incisional atrial tachycardia occurs due to reentry around surgical scars. Pharmacological therapy is often ineffective. This study assessed the efficacy of a novel mapping system (LocaLisa) in facilitating catheter ablation of incisional atrial tachycardia circuits. Eight consecutive patients (four men, four women) with incisional atrial tachycardia (median age 23.5 years, range 9-44) following previous repair of congenital heart defects underwent transcatheter mapping and ablation of the arrhythmogenic substrate using a mapping system (LocaLisa) that allows localization of endocardial electrodes in a three-dimensional space. Critical isthmuses for the tachycardia circuits were identified by demonstrating concealed entrainment using standard pacing and mapping techniques. Scars and natural anatomic barriers were marked on the LocaLisa image. Lines of block were created by radiofrequency current application between scars and natural anatomic barriers, or between two scars, to close isthmuses demonstrated to be critical for the reentrant circuit. All lines of block were verified in both directions. All reentrant circuits around incisions were successfully ablated. Seven additional tachycardia mechanisms were identified in four patients (common atrial flutter [n = 4], atrioventricular nodal [AVN] reentry [n = 2], ectopic atrial tachycardia [n = 1]) and were also ablated in a single session. The mean fluoroscopy time was 28.4 +/- 13.8 minutes. All patients are arrhythmia-free at a median follow-up of 20 (6-22) months. The LocaLisa mapping system is effective for identification of scars and ablation targets, for confirming lines of block, and facilitating ablation of complex reentrant circuits.
切口性房性心动过速是由于围绕手术瘢痕的折返而发生的。药物治疗往往无效。本研究评估了一种新型标测系统（LocaLisa）在促进切口性房性心动过速环路导管消融中的疗效。连续8例（4男，4女）先天性心脏病既往修复术后发生切口性房性心动过速的患者（中位年龄23.5岁，范围9 - 44岁），使用一种能够在三维空间定位心内膜电极的标测系统（LocaLisa）进行经导管标测和致心律失常基质的消融。通过使用标准起搏和标测技术证明隐匿性拖带来确定心动过速环路的关键峡部。在LocaLisa图像上标记瘢痕和天然解剖屏障。通过在瘢痕与天然解剖屏障之间或两个瘢痕之间施加射频电流来创建阻滞线，以封闭被证明对折返环路至关重要的峡部。所有阻滞线均在两个方向得到验证。所有围绕切口的折返环路均成功消融。在4例患者中还识别出另外7种心动过速机制（常见房扑[n = 4]、房室结折返性心动过速[n = 2]、房性异位性心动过速[n = 1]），并在单次手术中也进行了消融。平均透视时间为28.4±13.8分钟。在中位随访20（6 - 22）个月时，所有患者均无心律失常。LocaLisa标测系统在识别瘢痕和消融靶点、确认阻滞线以及促进复杂折返环路的消融方面是有效的。
