Cavaco Diogo, Adragão Pedro, Morgado Francisco, Aguiar Carlos, Chotalal Dipali, Palos José, Bonhorst Daniel, Seabra-Comes Ricardo
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal.
Rev Port Cardiol. 2002 Apr;21(4):407-18.
Variable success rates in the ablation of atrial tachycardias using conventional electrophysiology have been achieved. There is no precise relation between P wave morphology in surface ECG and atrial electrophysiology, and this fact makes it more difficult to locate ectopic atrial foci. The CARTO system creates atrial activation maps that relate an anatomical location to an electrical potential. The aim of this study was to evaluate the efficacy of CARTO guided radiofrequency (RF) ablation of atrial foci. The population consisted of 10 consecutive patients with atrial tachycardia resistant to more than 2 drugs, 7 female, mean age 45 +/- 12 years. CARTO activation maps were constructed based on atrial tachycardia or premature beats. Radiofrequency energy was applied to the earliest activation zone. Immediate success was defined as suppression of ectopic atrial activity. Ectopic foci were located on the ostium of the coronary sinus (3 patients), crista terminalis (1 patient), right atrial appendage (1 patient), interatrial septum (1 patient) and in the pulmonary veins (4 patients). The activation maps contained 85 +/- 35 points. The number of RF applications ranged from 1 to 11 (mean 4). Immediate and 6 month success rate was 90%. We were not able to treat one patient with a focus in the right atrial appendage. No attempt was made to limit procedure or fluoroscopy time in our study. Nonetheless all procedures lasted less than 150 min, and fluoroscopy times were less than 30 minutes.
The CARTO system precisely located ectopic atrial foci, allowing a high success rate in the ablation of focal atrial tachycardias.
使用传统电生理学方法消融房性心动过速的成功率各不相同。体表心电图P波形态与心房电生理学之间没有精确的关系，这一事实使得定位异位心房灶更加困难。CARTO系统可创建将解剖位置与电位相关联的心房激动图。本研究的目的是评估CARTO指导下射频（RF）消融心房灶的疗效。研究对象为连续10例对2种以上药物耐药的房性心动过速患者，其中女性7例，平均年龄45±12岁。根据房性心动过速或早搏构建CARTO激动图。将射频能量施加于最早激动区。即刻成功定义为异位心房活动受到抑制。异位灶位于冠状窦口（3例）、界嵴（1例）、右心耳（1例）、房间隔（1例）和肺静脉（4例）。激动图包含85±35个点。射频应用次数为1至11次（平均4次）。即刻成功率和6个月成功率为90%。我们未能治疗1例右心耳有病灶的患者。在我们的研究中未尝试限制手术或透视时间。尽管如此，所有手术持续时间均少于150分钟，透视时间少于30分钟。
CARTO系统精确地定位了异位心房灶，使局灶性房性心动过速的消融成功率很高。
