Deutsches Herzzentrum München, Lazarettstrasse. 36, 80636 Munich, Germany.
Europace. 2013 Jun;15(6):886-91. doi: 10.1093/europace/eus402. Epub 2013 Jan 25.
Data about the acute and long-term outcome of catheter ablation in patients with D-transposition of the great arteries (d-TGA) post-Mustard/Senning operation are scarce.
This single-centre retrospective analysis includes 26 patients (mean age 28.7 ± 6.7 years, 8 females) after Mustard (n = 15) or Senning (n = 11) operation who underwent catheter ablation for intra-atrial re-entrant tachycardia (IART) or atrioventricular nodal re-entrant tachycardia (AVNRT) from January 2004 to May 2011. The electrophysiological studies were performed using a three-dimensional mapping system (CARTO). Remote magnetic navigation (RMN) was available since 2008. Follow-up on an outpatient basis was conducted 3, 6, and 12 months after ablation and yearly thereafter. In the 26 patients, 34 procedures were performed (one procedure n = 19, two n = 6, and three n = 1). Overall, 34 tachycardia forms (IART n = 30; AVNRT n = 4) were ablated manually (n = 25) or by RMN (n = 9). Acute success reached in 29/34 forms (85.3%). Mean fluoroscopy time (FT) was 28.2 ± 20.7 min and mean procedure duration (PD) was 290.9 ± 107.6 min. After a mean follow-up of 34.1 ± 24.5 months, 25/26 (96.2%) patients were free from IART or AVNRT. In the nine RMN ablations (mean follow-up 14.2 ± 5.8 months) acute and long-term success was 100%. Fluoroscopy time and PD were significantly reduced using RMN compared with manual ablation (11.9 ± 6.2 vs. 34.6 ± 20.6 min, 225.7 ± 24.1 vs. 312 ± 118.2 min, P = 0.02).
Catheter ablation of IART or AVNRT in patients post-Mustard/Senning operation for d-TGA has a high acute success rate. The recurrence rate for IART is about 30%; however, after a second ablation, long-term results are excellent. Remote magnetic navigation seems to improve single-procedure acute and long-term success and significantly reduces FT and PD.
关于法洛四联症根治术后行改良 Mustard 或 Senning 手术的 D 型大动脉转位（d-TGA）患者行导管消融术的急性和长期疗效的数据较为匮乏。
本单中心回顾性分析纳入了 2004 年 1 月至 2011 年 5 月间因房内折返性心动过速（IART）或房室结折返性心动过速（AVNRT）行导管消融术的 26 例患者（平均年龄 28.7 ± 6.7 岁，女性 8 例）。这些患者均在改良 Mustard 或 Senning 手术后接受了电生理检查。电生理研究采用了三维标测系统（CARTO）。自 2008 年起，我们开始使用远程磁导航（RMN）技术。消融术后 3、6 和 12 个月以及此后每年进行一次门诊随访。26 例患者共进行了 34 次消融手术（1 次手术 19 例，2 次手术 6 例，3 次手术 1 例）。其中，手动消融 25 次，RMN 消融 9 次。整体上，共消融了 34 种心动过速（IART 30 种，AVNRT 4 种）。29/34 种心动过速即刻消融成功（85.3%）。平均透视时间（FT）为 28.2 ± 20.7 min，平均手术时间（PD）为 290.9 ± 107.6 min。平均随访 34.1 ± 24.5 个月后，26 例患者中有 25 例（96.2%）IART 或 AVNRT 无复发。9 例 RMN 消融患者（平均随访 14.2 ± 5.8 个月）即刻和长期消融成功率均为 100%。与手动消融相比，RMN 可显著减少透视时间和手术时间（11.9 ± 6.2 vs. 34.6 ± 20.6 min，225.7 ± 24.1 vs. 312 ± 118.2 min，P = 0.02）。
改良 Mustard 或 Senning 术后行 D 型大动脉转位患者的房内折返性心动过速或房室结折返性心动过速的导管消融术具有较高的即刻成功率。IART 的复发率约为 30%；然而，行第二次消融后，长期效果极好。远程磁导航似乎可以提高单次手术的即刻和长期成功率，同时显著减少透视时间和手术时间。
