de Groot Natasja M S, Lukac Peter, Blom Nico A, van Kuijk Jan Peter, Pedersen Anders K, Hansen Peter S, Delacretaz Etienne, Schalij Martin J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Circ Arrhythm Electrophysiol. 2009 Jun;2(3):242-8. doi: 10.1161/CIRCEP.108.828137. Epub 2009 Jun 3.
Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy of late postoperative SVT in patients with univentricular heart.
Patients with univentricular heart (n=19, 11 male; age, 29+/-9 years) referred for ablation of SVT were studied. Ablation was guided by 3D electroanatomic mapping in all but 2 procedures. A total of 41 SVT were diagnosed as intra-atrial reentrant tachycardia (n=30; cycle length, 310+/-68 ms), typical atrial flutter (n=4; cycle length, 288+/-42 ms), focal atrial tachycardia (n=6; cycle length, 400+/-60 ms), and atrial fibrillation (n=1). Ablation was successful in 73% of intra-atrial reentrant tachycardia, 75% of atrial flutter, and all focal atrial tachycardia and focal atrial fibrillation. During the follow-up period of 53+/-34 months, 2 patients were lost to follow-up, 3 died of heart failure, 2 underwent heart transplantation, and 1 underwent conduit replacement. Of the remaining group, 8 had sinus rhythm and 3 had SVT.
Focal and reentrant mechanisms underlie postoperative SVT in patients with univentricular heart. Successive SVT developing over time may be caused by different mechanisms. Ablative therapy is potentially curative, with a procedural success rate of 78%. In patients who had multiple ablation procedures, the SVT originated from different atrial sites, suggesting that these new SVT were caused by progressive atrial disease. Despite recurrent SVT, sinus rhythm at the end of the follow-up period was achieved in 72%.
导管消融已发展成为一种可能治愈单心室心脏患者室上性心动过速（SVT）的治疗方式。然而，消融手术的长期结果尚不清楚。我们评估了单心室心脏患者术后晚期SVT消融治疗的手术及长期结果。
对因SVT前来接受消融治疗的单心室心脏患者（n = 19，11例男性；年龄29±9岁）进行了研究。除2例手术外，其余均采用三维电解剖标测指导消融。共诊断出41例SVT，其中房内折返性心动过速（n = 30；周长310±68毫秒）、典型心房扑动（n = 4；周长288±42毫秒）、局灶性房性心动过速（n = 6；周长400±60毫秒）和心房颤动（n = ）。房内折返性心动过速的消融成功率为73%，心房扑动为75%，所有局灶性房性心动过速和局灶性心房颤动均成功消融。在53±34个月的随访期内，2例患者失访，3例死于心力衰竭，2例接受心脏移植，1例接受管道置换。其余患者中，8例为窦性心律，3例有SVT。
单心室心脏患者术后SVT的机制为局灶性和折返性。随时间推移出现的连续性SVT可能由不同机制引起。消融治疗可能具有治愈性，手术成功率为78%。在接受多次消融手术的患者中，SVT起源于不同的心房部位，提示这些新的SVT是由进行性心房疾病引起的。尽管SVT复发，但随访期末窦性心律的实现率为72%。
