利用双电位屏障识别腔静脉-三尖瓣峡部的功能性峡部，以促进峡部依赖性房扑的导管消融。

Use of double-potential barrier to identify functional isthmus at the cavotricuspid isthmus for facilitating catheter ablation of isthmus-dependent atrial flutter.

作者信息

Lai Ling-Ping, Lin Jiunn-Lee, Lin Jih-Min, Du Chao-Cheng, Tseng Yung-Zu, Huang Shoei K Stephen

机构信息

Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chun-Shan S. Road, Taipei, Taiwan.

出版信息

J Cardiovasc Electrophysiol. 2004 Apr;15(4):396-401. doi: 10.1046/j.1540-8167.2004.03424.x.

DOI:10.1046/j.1540-8167.2004.03424.x

PMID:15089986

Abstract

INTRODUCTION

The aim of the study was to identify an alternative target for more effective radiofrequency catheter ablation (RFCA) of isthmus-dependent atrial flutter (AFL).

METHODS AND RESULTS

We hypothesized that a functional isthmus formed by preexisting double potential barrier at the cavotricuspid isthmus (CTI) could serve as a new target site for facilitating RFCA of AFL. Forty-three consecutive patients with recurrent isthmus-dependent AFL were studied using three-dimensional navigated magnetic mapping and ablation technique. Twenty patients (47%, group A) were shown to have a narrower functional channel at the CTI (functional isthmus). The remaining 23 patients did not have this feature (53%, group B). In group A, double potentials were clustered near the border of the inferior vena cava (IVC) of the CTI and served as a functional channel along the tricuspid annulus (TA). The interspike interval of double potentials was 87 +/- 26 ms near the IVC border and 45 +/- 17 ms (P < 0.0001) near the TA border of CTI. RFCA targeting at the functional isthmus in group A resulted in interruption of bidirectional transisthmus conduction with fewer radiofrequency pulses (6.7 +/- 4.7 in group A vs 21.1 +/- 17.1 pulses in group B, P < 0.001), shorter ablation line (11.6 +/- 4.0 mm vs 37.8 +/- 7.2 mm, P < 0.0001) with no arrhythmia recurrence. These functional isthmuses were found to be located at the lateral third of CTI in 12 patients, middle third in 7, and medial third in 1. This finding is different from that obtained by the conventional method in group B (lateral in 5, middle in 16, medial in 2, P < 0.038).

CONCLUSION

In our study, a functional, rather than anatomic, isthmus formed by preexisting double-potential barrier at the CTI was identified in 47% of patients with isthmus-dependent AFL. It is a useful guide to facilitate RFCA of isthmus-dependent AFL.

摘要

引言

本研究的目的是确定一个替代靶点，以更有效地进行峡部依赖性房扑（AFL）的射频导管消融（RFCA）。

方法与结果

我们假设由腔静脉三尖瓣峡部（CTI）预先存在的双电位屏障形成的功能性峡部可作为促进AFL的RFCA的新靶点。连续43例复发性峡部依赖性AFL患者采用三维导航磁标测和消融技术进行研究。20例患者（47%，A组）在CTI（功能性峡部）显示有较窄的功能性通道。其余23例患者没有此特征（53%，B组）。在A组中，双电位聚集在CTI下腔静脉（IVC）边界附近，并沿着三尖瓣环（TA）形成一个功能性通道。双电位的峰间间期在IVC边界附近为87±26毫秒，在CTI的TA边界附近为45±17毫秒（P<0.0001）。针对A组功能性峡部的RFCA导致双向峡部传导中断，所需射频脉冲较少（A组为6.7±4.7次，B组为21.1±17.1次脉冲，P<0.001），消融线较短（11.6±4.0毫米对37.8±7.2毫米，P<0.0001），且无心律失常复发。发现这些功能性峡部在12例患者中位于CTI的外侧三分之一处，7例位于中间三分之一处，1例位于内侧三分之一处。这一发现与B组传统方法获得的结果不同（外侧5例，中间16例，内侧2例，P<0.038）。