University Hospital Eppendorf, University Heart Center, Department of Electrophysiology, D-20246 Hamburg, Germany.
Circ Arrhythm Electrophysiol. 2010 Apr;3(2):160-9. doi: 10.1161/CIRCEP.109.899021. Epub 2010 Feb 4.
Atrial tachycardias (AT) often occur after ablation of long-lasting persistent AF (CAF) and are difficult to treat conservatively. This study evaluated mechanisms and success rates of conventional mapping and catheter ablation of recurrent ATs occurring late after stepwise ablation of CAF.
A total of 320 patients underwent de novo ablation of CAF using a stepwise ablation approach in 2006 to 2007 at our institution. This study comprised patients who presented with recurrent ATs at their first redo procedure after initial de novo CAF ablation. All procedures were guided by conventional mapping techniques exclusively. Sixty-one patients (63+/-10 years, 14 women) presented with their clinical AT at their redo procedure 7.7+/-4.4 months after initial de novo CAF ablation. A total of 133 ATs (2.2+/-0.9 per patient) were mapped. Forty-four (72%) were due to reentry; 17 (28%) were focal ATs. Reentry ATs were mainly characterized as roof and perimitral flutter (43% and 34%, respectively). Focal ATs mainly originated from the great thoracic veins (pulmonary veins: 41%, coronary sinus: 23%). Forty-five (74%) patients had conduction recovery of at least 1 pulmonary vein (mean, 1.2+/-0.8). Overall, 124 (93%) ATs could be ablated successfully. The mean procedure duration was 181+/-59 minutes, with a mean fluoroscopy time of 45+/-21 minutes. After a mean follow-up of 21+/-4 months, 50 (82%) patients were free of any arrhythmia recurrences after a single redo procedure.
Although late recurrent ATs may have complex mechanisms, catheter ablation guided exclusively by conventional techniques is highly effective with excellent acute and long-term success rates.
持续性心房颤动（CAF）消融后常发生房性心动过速（AT），且保守治疗较为困难。本研究评估了逐步消融 CAF 后晚期复发 AT 的常规标测和导管消融的机制和成功率。
本机构于 2006 年至 2007 年首次采用逐步消融法对 320 例患者进行了 CAF 的消融治疗。本研究包括首次 CAF 消融后首次再次消融时出现复发性 AT 的患者。所有手术均仅采用常规标测技术指导。61 例患者（63+/-10 岁，14 例女性）在初始 CAF 消融后首次再次消融时出现临床 AT，距初始 CAF 消融时间为 7.7+/-4.4 个月。共标测到 133 次 AT（每位患者 2.2+/-0.9 次）。其中 44 次（72%）为折返性 AT，17 次（28%）为局灶性 AT。折返性 AT 主要表现为房顶和周边的颤动（分别为 43%和 34%）。局灶性 AT 主要起源于大胸静脉（肺静脉：41%，冠状窦：23%）。45 例（74%）患者至少有 1 条肺静脉（平均 1.2+/-0.8）的传导恢复。总体而言，124 例（93%）AT 消融成功。平均手术时间为 181+/-59 分钟，平均透视时间为 45+/-21 分钟。平均随访 21+/-4 个月后，50 例（82%）患者在单次再次消融后无任何心律失常复发。
尽管晚期复发性 AT 可能具有复杂的机制，但仅采用常规技术指导的导管消融具有极高的有效性，且具有良好的急性和长期成功率。
