II Medizinische Abteilung, Asklepios Klinik St Georg, Hamburg, Germany.
Circ Arrhythm Electrophysiol. 2010 Feb;3(1):24-31. doi: 10.1161/CIRCEP.109.879015. Epub 2009 Dec 2.
Macroreentrant atrial tachycardia (AT) involving the right atrial free wall (RAFW) has been reported in patients without atriotomy. Catheter ablation of these ATs remains challenging due to the multiple morphologies of ATs with unstable reentrant circuits in some patients. The purpose of this study was to clarify the electrophysiological characteristics of these ATs and attempt the novel approach for catheter ablation.
Electrophysiological study and catheter ablation were performed in 17 patients (14 men; 71 [quartile 1, 67; quartile 3, 76] years) with reentrant ATs originating from the RAFW using 3D mapping. All patients had no history of cardiac surgery. Clinical ATs with stable cycle length and atrial activation were identified in 11 patients (group A). All ATs were successfully ablated. In the remaining 6 patients, clinical tachycardia continuously changed, with a different cycle length and P-wave morphology and atrial activation sequence during mapping or entrainment study (group B). A complete isolation of the RAFW was attempted in group B. After complete isolation was achieved in 5 of 6 patients, ATs were not induced in these 6 patients. The number of previous failed catheter ablations and induced ATs were higher in group B than in group A. During 31 (19; 37) months of follow-up, AT recurrence developed in 27% patients from group A and 33% from group B.
Multiple and unstable macroreentrant ATs from the RAFW can occur in patients without a history of cardiac surgery. The RAFW isolation has the potential to abolish all ATs.
已报道在无剖胸术的患者中存在涉及右房游离壁（RAFW）的大折返性房性心动过速（AT）。由于一些患者折返环不稳定且 AT 存在多种形态，这些 AT 的导管消融仍然具有挑战性。本研究旨在阐明这些 AT 的电生理特征，并尝试新的导管消融方法。
对 17 例起源于 RAFW 的折返性 AT 患者（14 例男性；71 [四分位距 1，67；四分位距 3，76] 岁）使用三维标测系统进行电生理研究和导管消融。所有患者均无心脏手术史。11 例患者（A 组）存在稳定周长和心房激动的临床 AT。所有 AT 均成功消融。在其余 6 例患者中，临床心动过速持续变化，在标测或拖带研究时具有不同的周长和 P 波形态及心房激动顺序（B 组）。尝试对 RAFW 进行完全隔离。在 6 例患者中，5 例实现完全隔离后，这些患者的 AT 均未被诱出。B 组的既往导管消融失败次数和诱发出的 AT 均多于 A 组。在 31（19；37）个月的随访中，A 组有 27%的患者和 B 组有 33%的患者出现 AT 复发。
在无心脏手术史的患者中，可能存在来自 RAFW 的多种不稳定的大折返性 AT。RAFW 隔离有可能消除所有 AT。
