Dong Jun, Zrenner Bernhard, Schreieck Jürgen, Deisenhofer Isabel, Karch Martin, Schneider Michael, Von Bary Christian, Weyerbrock Sonja, Yin Yuehui, Schmitt Claus
The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0409, USA.
Heart Rhythm. 2005 Jun;2(6):578-91. doi: 10.1016/j.hrthm.2005.03.014.
Experience in catheter ablation of left atrial (LA) focal tachycardia and information about interatrial electrical connections during LA focal tachycardia are limited.
The purpose of this study was to describe our experience in electroanatomic mapping-guided catheter ablation of LA focal tachycardia and to investigate interatrial electrical connections during LA focal tachycardias.
Thirty-three patients undergoing catheter ablation for LA focal tachycardia guided by electroanatomic mapping were reported. Interatrial electrical connections were analyzed in LA focal tachycardias with biatrial electroanatomic maps.
Of the 35 LA focal tachycardias (cycle length 309 +/- 100 ms) mapped, 19 (54%) originated from the pulmonary veins (PVs), 6 (17%) from the mitral annulus, 3 (8.6%) from LA roof, 3 (8.6%) from LA posterior wall, 2 (5.7%) from LA appendage, and 2 (5.7%) from LA septum. Fourteen of the 19 PV tachycardias (74%) were located in proximity to PV ostia. In 14 (7 PV, 7 non-PV) LA focal tachycardias with biatrial electroanatomic maps, posterior right atrium breakthrough sites at the intercaval area were identified in 7 PV tachycardias and 1 non-PV tachycardia. Five of the 7 PV tachycardias used only the posterior breakthrough for interatrial propagation. Procedural success was achieved in 33 of 35 LA focal tachycardias (94%) in 31 patients. During 23 +/- 19 months of follow-up, 2 patients (6%) had recurrence of ablated tachycardia, and 3 (10%) developed new LA focal tachycardias.
The PVs and the mitral annulus were the main sources of LA focal tachycardias. The majority of PV tachycardias originated from PV ostia. A posterior interatrial connection appeared to play a major role in interatrial electrical propagation during PV tachycardias. Electroanatomic mapping facilitated precise localization of LA focal tachycardias and achievement of a high rate of ablation success.
左房局灶性心动过速的导管消融经验以及左房局灶性心动过速期间房间电连接的相关信息有限。
本研究旨在描述我们在电解剖标测指导下进行左房局灶性心动过速导管消融的经验，并研究左房局灶性心动过速期间的房间电连接。
报告了33例在电解剖标测指导下进行左房局灶性心动过速导管消融的患者。使用双房电解剖图分析左房局灶性心动过速中的房间电连接。
在标测的35例左房局灶性心动过速（周长309±100毫秒）中，19例（54%）起源于肺静脉，6例（17%）起源于二尖瓣环，3例（8.6%）起源于左房顶，3例（8.6%）起源于左房后壁，2例（5.7%）起源于左心耳，2例（5.7%）起源于房间隔。19例肺静脉心动过速中有14例（74%）位于肺静脉开口附近。在14例（7例肺静脉，7例非肺静脉）有双房电解剖图的左房局灶性心动过速中，在7例肺静脉心动过速和1例非肺静脉心动过速中，在下腔静脉间区域发现了右房后壁突破位点。7例肺静脉心动过速中有5例仅利用后壁突破进行房间传导。35例左房局灶性心动过速中的33例（94%）在31例患者中手术成功。在23±19个月的随访期间，2例患者（6%）消融的心动过速复发，3例（10%）出现新的左房局灶性心动过速。
肺静脉和二尖瓣环是左房局灶性心动过速的主要来源。大多数肺静脉心动过速起源于肺静脉开口。在后壁房间连接似乎在肺静脉心动过速期间的房间电传导中起主要作用。电解剖标测有助于左房局灶性心动过速的精确定位并实现高消融成功率。
