Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Ann Thorac Surg. 2010 Aug;90(2):510-5. doi: 10.1016/j.athoracsur.2010.04.063.
Minimally invasive pulmonary vein isolation was developed as a treatment of lone atrial fibrillation. Until recently, electrophysiological studies in patients with recurrent arrhythmias had not been described.
One hundred thirty patients underwent mini-maze pulmonary vein isolation. We performed catheter ablation guided by CARTO mapping in 8 recurrent patients (mean 61.8 + or - 12.7 years old; male:female ratio, 5:3) 5.0 + or - 14 months after the original surgical procedure.
Recurrent atrial fibrillation occurred in 4 patients, atrial tachycardia occurred in 1 patient, and atrial flutter was present in 3 patients. CARTO mapping revealed that in 3 atrial fibrillation patients, gaps in the lesion were present at the roof and the bottom of the pulmonary vein. One of these patients was also found to have microreentry around the base of the left atrial appendage. The fourth recurrent atrial fibrillation patient was found to have a gap in the pulmonary vein isolation ring. One patient with atrial tachycardia was documented to have ectopic focus between the left atrial appendage and left superior pulmonary vein. In the 3 patients with atrial flutter, it was found to be localized to the mitral valve annulus in 2 patients, and to the left atrial roof of the remaining patient. All 8 patients underwent ablation successfully. At the latest follow-up, all patients were free of arrhythmias and independent of antiarrhythmic drugs.
Pulmonary vein conduction at the roof and the bottom of the pulmonary vein after pulmonary vein isolation is the dominant factor responsible for recurrent atrial tachyarrhythmia. Left atrial-related flutter is a common form of arrhythmia.
微创肺静脉隔离术是作为治疗孤立性心房颤动的一种方法而发展起来的。直到最近，对复发性心律失常患者的电生理研究仍未被描述。
130 例患者接受了微创迷宫肺静脉隔离术。我们对 8 例复发性心律失常患者（平均年龄 61.8 ± 12.7 岁；男女比例 5:3）在原始手术 5.0 ± 14 个月后进行了基于 CARTO 图谱的导管消融。
4 例患者出现复发性心房颤动，1 例患者出现房性心动过速，3 例患者出现心房扑动。CARTO 图谱显示，在 3 例心房颤动患者中，肺静脉病变的顶部和底部存在间隙。其中 1 例患者还发现左心耳基部存在微小折返。第 4 例复发性心房颤动患者发现肺静脉隔离环存在间隙。1 例房性心动过速患者记录到左心耳与左上肺静脉之间存在异位灶。在 3 例心房扑动患者中，有 2 例患者的定位在二尖瓣环，另外 1 例患者在左心房顶部。所有 8 例患者均成功进行了消融。在最新的随访中，所有患者均无心律失常，无需抗心律失常药物。
肺静脉隔离术后肺静脉顶部和底部的肺静脉传导是导致复发性房性心动过速的主要因素。左心耳相关的房扑是一种常见的心律失常形式。
