Leonelli F M, Tomassoni G, Richey M, Natale A
Cardiology Associates of Mobile, Mobil, Alabama 36608, USA.
Pacing Clin Electrophysiol. 2001 Nov;24(11):1653-9. doi: 10.1046/j.1460-9592.2001.01653.x.
Incisional atrial reentrant tachycardias are macroreentrant arrhythmias in which surgical scars or prosthetic material constitute one of the constraining barriers of the circuit. Accurate reconstruction based on fluoroscopy-guided endocardial mapping of the reentrant circuit is often incomplete and time consuming explaining, at least in part, the modest long-term results of this technique. Mapping and ablation of these arrhythmias using a three-dimensional nonfluoroscopic mapping system that allows electroanatomic reconstruction of the reentrant circuit could help in identifying the ablation targets and improve long-term outcome. The study included 20 patients (12 men, mean age 45+/-18 years) with corrected congenital heart disease (4 patients), coronary artery bypass surgery (7 patients), mitral or aortic valve replacement or reconstruction (6 patients), valve replacement and coronary revascularization (2 patients), and mitral valve replacement with maze procedure for atrial fibrillation (1 patient). Endocardial mapping with this novel system was complemented by standard electrophysiological techniques used to identify a critical isthmus of conduction. Two or more nonconductive areas of atrial tissue or surgical prosthetic material delimiting a critical isthmus of conduction were identified in every patient. Radiofrequency linear applications spanning two to more boundaries successfully eliminated the tachycardia in every patient. At a follow-up of 11.5+/-5.1 months (range 17-5 months), two (10%) patients developed a new clinical arrhythmia. The remaining 18 had no recurrences off medical therapy. Mean fluoroscopy time was 45.7+/-15.2 minutes for patients with a single scar and 89+/-41.2 minutes in patients with two or more scars. In conclusions, this new nonfluoroscopic mapping system offers the opportunity to achieve a high rate of cure of complex macroreentrant atrial tachycardias by facilitating reconstruction of the macroreentrant circuit and its boundaries.
切口性房性折返性心动过速是大折返性心律失常，手术瘢痕或人工材料构成折返环路的限制屏障之一。基于荧光透视引导下心内膜折返环路标测的精确重建往往不完整且耗时，这至少部分解释了该技术长期效果不佳的原因。使用三维非荧光透视标测系统对这些心律失常进行标测和消融，该系统可实现折返环路的电解剖重建，有助于识别消融靶点并改善长期疗效。该研究纳入了20例患者（12例男性，平均年龄45±18岁），其中包括矫正型先天性心脏病患者4例、冠状动脉搭桥手术患者7例、二尖瓣或主动脉瓣置换或重建患者6例、瓣膜置换及冠状动脉血运重建患者2例、二尖瓣置换并迷宫手术治疗心房颤动患者1例。用这种新型系统进行心内膜标测，并辅以用于识别关键传导峡部的标准电生理技术。在每位患者中均识别出两个或更多界定关键传导峡部的心房组织或手术人工材料的非传导区域。跨越两个或更多边界的射频线性消融成功消除了每位患者的心动过速。在11.5±5.1个月（范围17 - 5个月）的随访中，2例（10%）患者出现了新的临床心律失常。其余18例患者在未接受药物治疗的情况下无复发。单个瘢痕患者的平均透视时间为45.7±15.2分钟，两个或更多瘢痕患者的平均透视时间为89±41.2分钟。总之，这种新的非荧光透视标测系统通过促进大折返环路及其边界的重建，为实现复杂大折返性房性心动过速的高治愈率提供了机会。
