Lascault G, Copie X, Touche T, Piot O, Laperche T, Paziaud O, Porte J-M, Scheuble C
Centre cardiologique du Nord, 32-36, avenue des Moulins-Gémeaux, 93200 Saint-Denis, France.
Ann Cardiol Angeiol (Paris). 2010 Jun;59(3):125-30. doi: 10.1016/j.ancard.2010.04.007. Epub 2010 May 6.
Radiofrequency ablation is the only curative treatment of common atrial flutter. The aim of the treatment is to create a line of bidirectional block at the level of the cavo-tricuspid isthmus. This objective can be achieved in the vast majority of the patients. However, it may difficult or even not possible to create an isthmus block. The anatomy of the right atrium is subject to important variations, especially at the isthmus level. We therefore tested the hypothesis that these anatomic variations might influence the immediate outcome of cavo-tricuspid isthmus ablation. The anatomy of cavo-tricuspid isthmus was studied by trans-oesophageal echocardiography. The shape of the isthmus (concave or not), the presence of diverticula and the degree of development of the Eustachian ridge were analysed. From these data, the cavo-tricuspid anatomy was classified as simple or complex. The immediate outcome of radiofrequency ablation was reviewed in 94 patients (mean age of 63 years) according to the anatomy, simple or complex. When the anatomy was classified as simple, the success rate of radiofrequency ablation was 95.6%; when the anatomy was complex, the success rate was 76.9% (overall success rate for the entire population equal to 90.4%). The length of the cavo-tricuspid isthmus did not influence the outcome of radiofrequency ablation. In summary, it appears that the anatomy of cavo-tricuspid isthmus seems to play a role in the immediate outcome of radiofrequency ablation of cavo-tricuspid isthmus.
射频消融是治疗常见心房扑动的唯一根治性方法。治疗目的是在腔静脉-三尖瓣峡部水平建立一条双向阻滞线。这一目标在绝大多数患者中能够实现。然而，创建峡部阻滞可能困难甚至无法实现。右心房的解剖结构存在重要变异，尤其是在峡部水平。因此，我们检验了这样一个假设，即这些解剖变异可能会影响腔静脉-三尖瓣峡部消融的即刻效果。通过经食管超声心动图研究腔静脉-三尖瓣峡部的解剖结构。分析峡部的形状（是否凹陷）、憩室的存在情况以及欧氏嵴的发育程度。根据这些数据，将腔静脉-三尖瓣解剖结构分为简单型或复杂型。根据解剖结构简单或复杂，对94例患者（平均年龄63岁）射频消融的即刻效果进行了回顾。当解剖结构被分类为简单型时，射频消融的成功率为95.6%；当解剖结构为复杂型时，成功率为76.9%（整个人群的总体成功率为90.4%）。腔静脉-三尖瓣峡部的长度不影响射频消融的效果。总之，腔静脉-三尖瓣峡部的解剖结构似乎在腔静脉-三尖瓣峡部射频消融的即刻效果中发挥作用。
