Zheliakov E G, Ardashev A V, Belenkov Iu N
Kardiologiia. 2012;52(3):26-32.
To compare results of radiofrequency (RF) ablation (A) of mitral and inferior septal isthmuses in the left atrium for the treatment of perimitral atrial flutter (AF) in patients with atrial fibrillation previously subjected to RF isolation of pulmonary veins and modification of the left atrial anatomical arrhythmia substrate.
We treated 20 patients (3 women, mean age 57.1+/-9.3 years) with recurrent postablational perimitral AF verified by 3-dimensional reconstruction of left and right atrial activation by nonfluoroscopic mapping and pacing techniques of entrainment into tachycardia cycle. At first stage RFA was carried out in the region of mitral isthmus (its endocardial parts). At second stage RFA was performed in the region of coronary sinus (CS) roof (epicardial portions of the mitral isthmus). At the third stage RFA influences were applied in the region of inferior septal isthmus (endocardial portions of the inferioseptal isthmus). At the fourth stage RFA was applied in the region of roof of proximal CS (epicardial portions of inferioseptal isthmus).
Application of RF influences to endocardial parts of the mitral isthmus resulted in sinus rhythm (SR) restoration in 6 cases. Change of length of the tachycardia cycle was noted in 5cases. SR restoration was observed after RFA in the region of the roof of distal CS in 3 cases and change of length of the tachycardia cycle was noted in 2 more cases. RFA of epicardial parts of the inferioseptal isthmus resulted in SR restoration in 3 cases and in increase of atypical AF cycle length in 6 cases. In 12 cases SR was restored during RFA application in the region of the roof of proximal CS parts. RF influences in the region of endocardial (stage 1) and epicardial (stage 2) parts of the mitral isthmus resulted in SR restoration in 9 cases while continuation of RFA in the region of endocardial (stage 3) and epicardial (stage 4) parts of the inferioseptal isthmus led to SR restoration in the remaining 15 cases (p<0.05).
RFA of endocardial and epicardial parts of the inferioseptal isthmus significantly more often led to termination of perimitral atypical AF in patients previously operated because of atrial fibrillation.
比较在已接受肺静脉射频隔离及左房解剖性心律失常基质改良的房颤患者中，对左房二尖瓣峡部和下间隔峡部进行射频消融（RF）治疗二尖瓣周围房扑（AF）的效果。
我们对20例患者（3例女性，平均年龄57.1±9.3岁）进行了治疗，这些患者有复发性消融后二尖瓣周围房颤，通过非透视标测和心动过速周期拖带起搏技术对左右房激动进行三维重建得以证实。第一阶段在二尖瓣峡部区域（其心内膜部分）进行射频消融。第二阶段在冠状窦（CS）顶部区域（二尖瓣峡部的心外膜部分）进行射频消融。第三阶段在下间隔峡部区域（下间隔峡部的心内膜部分）施加射频影响。第四阶段在近端CS顶部区域（下间隔峡部的心外膜部分）进行射频消融。
对二尖瓣峡部的心内膜部分施加射频影响，6例患者恢复窦性心律（SR）。5例患者心动过速周期长度改变。在远端CS顶部区域进行射频消融后，3例患者恢复SR，另外2例患者心动过速周期长度改变。下间隔峡部心外膜部分的射频消融使3例患者恢复SR，6例患者非典型AF周期长度增加。在近端CS顶部区域进行射频消融时，12例患者恢复SR。对二尖瓣峡部的心内膜（第1阶段）和心外膜（第2阶段）部分施加射频影响，9例患者恢复SR，而在下间隔峡部的心内膜（第3阶段）和心外膜（第4阶段）部分继续进行射频消融，其余15例患者恢复SR（p<0.05）。
对于因房颤先前接受手术的患者，下间隔峡部的心内膜和心外膜部分进行射频消融更常显著导致二尖瓣周围非典型AF终止。
