Zrenner Bernhard, Dong Jun, Schreieck Jürgen, Ndrepepa Gjin, Meisner Hans, Kaemmerer Harald, Schömig Albert, Hess John, Schmitt Claus
Department of Cardiology, Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technischen Universität München, Munich, Germany.
J Cardiovasc Electrophysiol. 2003 Dec;14(12):1302-10. doi: 10.1046/j.1540-8167.2003.03292.x.
Intra-atrial reentrant tachycardia (IART) circuits after Mustard operation remain incompletely understood due to the complex atrial anatomy after extensive surgical procedures. The aim of this study was to delineate IART circuits and their relations to the individual anatomic boundaries in Mustard patients.
Twelve patients (10 men and 2 women; age 29 +/- 4.6 years) with atrial tachyarrhythmias after Mustard operation were included in this study. During 14 IARTs and 2 focal atrial tachycardias, electroanatomic mapping and entrainment mapping were performed in both the systemic venous atrium and the pulmonary venous atrium. The latter was accessed via a retrograde transaortic approach. Thirteen IARTs used a single-loop reentrant circuit, and 1 IART used a dual-loop reentrant circuit. Ten (77%) of 13 single-loop reentrant circuits used the tricuspid annulus (TA) as their central barrier. The remaining 3 IARTs rotated around the inferior vena cava (IVC) (n = 2) or ostium of the right upper pulmonary vein (n = 1). In 6 (60%) of the 10 peritricuspid IARTs, both pulmonary venous atrium and systemic venous atrium components of the mid-portion of the TA-IVC isthmus were demonstrated to be part of the reentry. Overall, 12 (86%) of 14 IARTs in 10 patients were successfully ablated by bridging two barriers that constrained the reentrant circuit. Eight (80%) of 10 peritricuspid circuits were abolished by linear ablation connecting the TA to the IVC (n = 4), incisional scar (n = 2), patch (n = 1), and atriotomy (n = 1).
In Mustard patients, the TA serves as the most frequent central barrier of IART. Biatrial electroanatomic mapping combined with entrainment mapping facilitates delineation of IART circuits in relation to their anatomic barriers and enables the design of individual ablation strategies to achieve high success.
由于广泛手术操作后心房解剖结构复杂，Mustard手术后的心房内折返性心动过速（IART）环路仍未完全明确。本研究的目的是描绘Mustard手术患者的IART环路及其与个体解剖边界的关系。
本研究纳入了12例Mustard手术后发生房性快速心律失常的患者（10例男性，2例女性；年龄29±4.6岁）。在14次IART和2次局灶性房性心动过速发作期间，对体静脉心房和肺静脉心房进行了电解剖标测和拖带标测。后者通过逆行经主动脉途径进入。13次IART使用单环折返环路，1次IART使用双环折返环路。13个单环折返环路中有10个（77%）以三尖瓣环（TA）作为其中心屏障。其余3次IART围绕下腔静脉（IVC）（n = 2）或右上肺静脉开口（n = 1）旋转。在10次围绕三尖瓣的IART中，有6次（60%）显示TA-IVC峡部中部的肺静脉心房和体静脉心房成分均为折返的一部分。总体而言，10例患者的14次IART中有12次（86%）通过跨越两个限制折返环路的屏障成功消融。10次围绕三尖瓣的环路中有8次（80%）通过连接TA与IVC的线性消融（n = 4）、切口瘢痕（n = 2）、补片（n = 1）和心房切开术（n = 1）消除。
在Mustard手术患者中，TA是IART最常见的中心屏障。双房电解剖标测结合拖带标测有助于描绘IART环路及其解剖屏障，并能设计个体化消融策略以取得高成功率。
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