Esato Masahiro, Hindricks Gerhard, Sommer Philipp, Arya Arash, Gaspar Thomas, Bode Kerstin, Bollmann Andreas, Wetzel Ulrike, Hilbert Sebastian, Kircher Simon, Eitel Charlotte, Piorkowski Christopher
University of Leipzig-Heart Center, Leipzig, Germany.
Heart Rhythm. 2009 Mar;6(3):349-58. doi: 10.1016/j.hrthm.2008.12.013. Epub 2008 Dec 10.
Mapping and ablation of atrial macroreentrant tachycardia focus on activation mapping with identification of the area of slow conduction.
The purpose of this study was to evaluate a new concept for analysis and treatment of macroreentrant tachycardia based on color-coded three-dimensional (3D) entrainment mapping and subsequent placement of strategic lesion lines.
Twenty-six patients presented with macroreentrant tachycardia (cycle length 329 +/- 70 ms). Using nonfluoroscopic systems (CARTO 12, NavX 14), sequential mapping of the target atrium was performed. On each mapping point, the 3D location was paired with color-coded entrainment information so that the reentrant circuit could be directly visualized.
Procedural duration, fluoroscopy time, and radiofrequency time measured 181 +/- 58, 37 +/- 19, and 31 +/- 17 minutes, respectively. Thirty-nine macroreentrant tachycardias were ablated: perimitral 9, around pulmonary vein ostium 6, through left atrial roof 5, around left atrial appendage 3, right atrial cavotricuspid isthmus dependent 6, around right atrial scar 2, around superior vena cava 1, within the septum 5, and within the coronary sinus 2. Tachycardia termination and noninducibility of any macroreentrant tachycardia was the procedural end-point. In case of left atrial macroreentrant tachycardia, pulmonary vein isolation was completed. Follow-up with serial 7-day Holter covered 302 +/- 82 days. Two (8%) patients experienced recurrences of a pretreated macroreentrant tachycardia.
In patients with macroreentrant tachycardia, color-coded 3D entrainment mapping is feasible to accurately determine and visualize the 3D location of the reentrant circuit and to plan a strategic ablation line concept. That approach, not targeting the area of slow conduction of the circuit, resulted in excellent procedural success (100%), with long-term freedom from any tachycardia recurrences in 88% of patients.
心房大折返性心动过速的标测与消融主要聚焦于激动标测以识别缓慢传导区域。
本研究旨在评估基于彩色编码三维（3D）拖带标测及后续放置策略性消融线的大折返性心动过速分析与治疗新概念。
26例患者表现为大折返性心动过速（周长329±70毫秒）。使用非透视系统（CARTO 12、NavX 14）对目标心房进行序贯标测。在每个标测点，将3D位置与彩色编码拖带信息配对，以便直接可视化折返环路。
手术时间、透视时间和射频时间分别为181±58、37±19和31±17分钟。共消融39例大折返性心动过速：二尖瓣环周围9例，肺静脉口周围6例，经左心房顶部5例，左心耳周围3例，右心房三尖瓣峡部依赖性6例，右心房瘢痕周围2例，上腔静脉周围1例，间隔内5例，冠状窦内2例。以任何大折返性心动过速的心动过速终止及不能诱发作为手术终点。对于左心房大折返性心动过速，完成肺静脉隔离。连续7天动态心电图随访302±82天。2例（8%）患者出现预处理大折返性心动过速复发。
对于大折返性心动过速患者，彩色编码3D拖带标测可准确确定并可视化折返环路的3D位置，并规划策略性消融线概念。该方法不针对折返环路的缓慢传导区域，手术成功率极佳（100%），88%的患者长期无任何心动过速复发。
