Kalarus Zbigniew, Kowalski Oskar, Lenarczyk Radosław, Pruszkowska-Skrzep Patrycja, Pluta Sławomir, Zeifert Bozena, Chodór Beata, Białkowski Jacek, Skalski Janusz, Zembala Marian
Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze.
Kardiol Pol. 2006 Dec;64(12):1343-8; discussion 1349.
Cardiac arrhythmias as a late complication following congenital heart surgery are encountered more and more frequently in clinical practice. The use of new electrophysiological methods of visualisation and mapping improves the efficacy of radio-frequency (RF) ablation of these arrhythmias.
To assess patterns of atrial arrhythmias following congenital heart surgery and to examine the efficacy of RF ablation using the electro-anatomical CARTO system.
Electrophysiological diagnostic study and RF ablation were performed in 24 consecutive patients (mean age 36+/-18 years) who had atrial arrhythmias following congenital heart surgery. The mechanism of arrhythmia (ectopic or reentrant) and strategy of RF ablation procedure were based on the results of the right atrial map performed during index arrhythmia.
The patients were divided into five groups according to the type of congenital heart surgery. The ASD group consisted of 17 patients who had undergone in the past surgery due to atrial septal defect, four patients had a history of surgery due to ventricular septal defect (VSD group), and one patient each had undergone surgery due to corrected transposition of the great arteries (ccTGA), tetralogy of Fallot (TF) or dual-outflow right ventricle (DORV). During diagnostic electrophysiological study typical atrial flutter (AFL) was diagnosed in nine patients from the ASD group, atypical AFL in three ASD patients, and ectopic atrial tachycardia (EAT) in six ASD patients. In one patient EAT was induced after ablation of typical AFL. Of the VSD patients, three had atypical AFL, and one had typical AFL. The patient following surgery for ccTGA had atypical AFL and EAT, whereas in the two remaining patients (DORV and TF) atypical AFL was demonstrated. The efficacy of the first session of RF ablation was 83% and no complications were observed. The efficacy of RF ablation of typical AFL was 90%, atypical AFL 78%, and EAT 86% (NS). During the long-term follow-up (24+/-17 months) arrhythmia recurrences were noted in 2 (10%) out of 20 patients who were effectively treated during the first RF ablation session.
Reentry is the most common electrophysiological mechanism of incisional tachycardias, followed by ectopic atrial tachycardia. RF ablation using the electro-anatomical CARTO system is effective and safe in this group of patients.
心脏心律失常作为先天性心脏手术后的晚期并发症在临床实践中越来越常见。使用新的电生理可视化和标测方法可提高对这些心律失常进行射频（RF）消融的疗效。
评估先天性心脏手术后房性心律失常的模式，并使用电解剖CARTO系统检查RF消融的疗效。
对24例先天性心脏手术后出现房性心律失常的连续患者（平均年龄36±18岁）进行电生理诊断研究和RF消融。心律失常的机制（异位或折返）和RF消融程序的策略基于在索引心律失常期间进行的右心房标测结果。
根据先天性心脏手术的类型将患者分为五组。房间隔缺损（ASD）组由17例过去因房间隔缺损接受手术的患者组成，4例有室间隔缺损（VSD组）手术史，1例分别因矫正型大动脉转位（ccTGA）、法洛四联症（TF）或双出口右心室（DORV）接受手术。在诊断性电生理研究中，ASD组9例患者诊断为典型房扑（AFL），3例ASD患者为非典型AFL，6例ASD患者为异位房性心动过速（EAT）。1例患者在典型AFL消融后诱发EAT。在VSD患者中，3例有非典型AFL，1例有典型AFL。ccTGA手术后的患者有非典型AFL和EAT，而其余2例患者（DORV和TF）表现为非典型AFL。首次RF消融的疗效为83%，未观察到并发症。典型AFL的RF消融疗效为90%，非典型AFL为78%，EAT为86%（无显著性差异）。在长期随访（24±17个月）中，20例在首次RF消融疗程中得到有效治疗的患者中有2例（10%）出现心律失常复发。
折返是切口性心动过速最常见的电生理机制，其次是异位房性心动过速。在这组患者中，使用电解剖CARTO系统进行RF消融是有效且安全的。
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