房颤消融术后伴周期长度交替的左房心动过速的消融：碎裂电图标测的意义
Ablation of left atrial tachycardia with cycle length alternans after atrial fibrillation ablation: significance of fractionated electrogram mapping.
作者信息
Mikhaylov Evgeny, Szili-Torok Tamas, Abramov Mikhail, Lebedev Dmitry
机构信息
Department of Electrophysiology and Cardiac Pacing, Almazov Federal Heart, Blood and Endocrinology Centre, Saint-Petersburg, Russian Federation.
出版信息
J Electrocardiol. 2011 Mar-Apr;44(2):164-70. doi: 10.1016/j.jelectrocard.2010.11.002. Epub 2010 Dec 18.
INTRODUCTION
Atrial tachycardia (AT) with cycle length alternans occurring after atrial fibrillation ablation has not been previously described.
METHODS
Among 66 patients with left AT, stable AT with 2 alternating cycles was registered in 5 cases. Activation mapping of both alternating cycles was performed in all 5 patients. Entrainment and fractionated electrogram mappings were also carried out.
RESULTS
Among 10 AT cycles, activation maps suggested underlying mechanism of 5 cycles (50%) in 3 patients. Entrainment pacing was helpful in 2 patients (confirmed mechanism of 2 AT cycles). Catheter ablation successfully terminated AT in all 5 patients: ablation of sites with fractionated potentials in 4 patients and mitral isthmus ablation in 1 patient.
CONCLUSION
Consecutive activation mapping of both AT cycles is feasible for mechanism determination in some patients. The results of our small study suggest that fractionated electrogram-guided ablation might be a reasonable approach for termination of this type of AT.
引言
心房颤动消融术后出现的伴有周期长度交替的房性心动过速（AT）此前尚未见报道。
方法
在66例左房AT患者中，5例记录到稳定的伴有2种交替周期的AT。对所有5例患者的2种交替周期均进行了激动标测。还进行了拖带和碎裂电图标测。
结果
在10个AT周期中，激动标测提示3例患者中5个周期（50%）的潜在机制。拖带起搏对2例患者有帮助（证实了2个AT周期的机制）。导管消融成功终止了所有5例患者的AT：4例患者消融了具有碎裂电位的部位，1例患者进行了二尖瓣峡部消融。
结论
对部分患者进行连续的2个AT周期激动标测以确定机制是可行的。我们的小型研究结果表明，碎裂电图引导下的消融可能是终止此类AT的合理方法。
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