Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
J Cardiovasc Electrophysiol. 2011 Sep;22(9):1013-7. doi: 10.1111/j.1540-8167.2011.02062.x. Epub 2011 May 3.
Atrial tachycardias (AT) are common after palliation or repair of congenital heart disease. The electroanatomic mechanism of AT in postoperative tetralogy of Fallot (TOF) and double outlet right ventricle (DORV) patients has not been fully explored.
Retrospective analysis of TOF or DORV patients was performed in the electrophysiology (EP) lab from January 1997 to March 2010. Sustained ATs were mapped using the Carto system (Biosense Webster, Diamond Bar, CA, USA). Fifty-eight patients were identified with 82 EP studies performed and 127 ATs identified. The first EP study for AT was performed at a median age of 35 years (2-58 years). Ninety-five IART circuits were identified, 5 in a figure-of-8 pattern. There were 13 focal ATs, 4 ectopic ATs, and 15 presentations of atrial fibrillation (AF). The cavotricuspid isthmus (CTI) was the critical area for ablation in the majority of TOF and DORV patients (53%). The CTI, along with the lateral RA wall, made up 85% of IART circuits. Excluding AF, the acute success rate for ablation was 90%. Of the 58 patients, 20 had additional ablation attempts, 19 within 3 years of their first ablation.
The CTI and lateral RA wall are critical corridors of conduction in 85% of IART circuits in TOF and DORV patients. The acute success rate for AT ablations is high, but a substantial number of patients have required additional ablation procedures. Recurrences may be reduced if both the CTI and lateral RA wall are targeted and blocked, even if the mapped circuit points only to 1 region.
在先天性心脏病的姑息或修复后，房性心动过速（AT）很常见。术后法洛四联症（TOF）和双出口右心室（DORV）患者 AT 的电解剖机制尚未得到充分探索。
对 1997 年 1 月至 2010 年 3 月在电生理（EP）实验室进行的 TOF 或 DORV 患者进行了回顾性分析。使用 Carto 系统（Biosense Webster，加利福尼亚州钻石吧）对持续性 AT 进行了映射。确定了 58 例患者，共进行了 82 次 EP 研究，确定了 127 次 AT。首次 EP 研究 AT 的中位年龄为 35 岁（2-58 岁）。确定了 95 个 IART 环，其中 5 个呈 8 字形。有 13 个局灶性 AT、4 个异位 AT 和 15 个房颤（AF）表现。大多数 TOF 和 DORV 患者（53%）消融的关键区域是腔静脉三尖瓣峡部（CTI）。CTI 加上右侧房侧壁占 IART 环的 85%。不包括 AF，消融的急性成功率为 90%。在 58 例患者中，有 20 例患者进行了额外的消融尝试，其中 19 例在首次消融后 3 年内进行。
CTI 和右侧房侧壁是 TOF 和 DORV 患者中 85%的 IART 环的关键传导途径。AT 消融的急性成功率很高，但相当多的患者需要额外的消融程序。如果同时靶向和阻断 CTI 和右侧房侧壁，即使映射电路仅指向 1 个区域，复发的可能性也会降低。
