Liew Reginald, Catanchin Andrei, Behr Elijah R, Ward David
Cardiology Department, Atkinson Morley Wing, St Georges Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK.
Europace. 2008 Aug;10(8):972-81. doi: 10.1093/europace/eun183.
Right atrial (RA) tachycardias may involve several mechanisms other than typical isthmus-dependent flutters, particularly in patients with congenital heart disease (CHD) or structural heart disease. We aimed at investigating the clinical utility of non-contact mapping in the diagnosis and ablation of these complex arrhythmias.
Non-contact mapping was used to treat RA tachycardias in 22 patients (12 with CHD and 10 without CHD). Ablation strategy consisted of creating linear lesions between scars (in macro-re-entrant circuits) or targeting areas of earliest activation and breakout points (in focal tachycardias). Eleven of the 12 tachycardias in the CHD group were atypical macro-re-entrant flutters. The majority (9 of 12) involved the RA free wall, whereas the remainder involved upper loop re-entry. In contrast, 9 of the 12 tachycardias in the non-CHD group were focal and 3 were macro-re-entrant. Acute procedural success was 88%. During a follow-up of 26 +/- 21 months, 90% of the patients reported either no symptoms (60%) or symptoms reduced to <50% pre-ablation levels (30%).
Non-contact mapping can provide important information on the mechanism of complex RA tachycardias in patients both with and without CHD. This can be useful in formulating ablation strategies.
右房（RA）心动过速可能涉及多种机制，而非典型的峡部依赖性房扑，特别是在先天性心脏病（CHD）或结构性心脏病患者中。我们旨在研究非接触式标测在这些复杂心律失常的诊断和消融中的临床应用价值。
对22例患者（12例患有CHD，10例未患CHD）使用非接触式标测治疗RA心动过速。消融策略包括在瘢痕之间形成线性病变（在大折返环路中）或针对最早激动区域和突破点（在局灶性心动过速中）。CHD组12例心动过速中有11例为非典型大折返性房扑。大多数（12例中的9例）涉及右房游离壁，其余涉及上环路折返。相比之下，非CHD组12例心动过速中有9例为局灶性，3例为大折返性。手术即刻成功率为88%。在26±21个月的随访期间，90%的患者报告无症状（60%）或症状减轻至消融前水平的<50%（30%）。
非接触式标测可为患有和未患有CHD的患者的复杂RA心动过速机制提供重要信息。这有助于制定消融策略。
