Mikhaylov Evgeny N, Mitrofanova Lubov B, Vander Marianna A, Tatarskiy Roman B, Kamenev Alexander V, Abramov Mikhail L, Szili-Torok Tamas, Lebedev Dmitry S
Department of Electrophysiology, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation; Department of Neuromodulation, Federal Almazov Medical Research Centre, Saint-Petersburg, Russian Federation.
J Cardiovasc Electrophysiol. 2015 Jan;26(1):28-35. doi: 10.1111/jce.12543. Epub 2014 Oct 20.
A left atrial (LA) anterior ablation line (AnL), connecting the mitral annulus and right pulmonary veins or a roof line, has been suggested as an alternative to mitral isthmus (MI) ablation for perimitral flutter (PMF). Theoretically, the AnL can exclude the LA septal wall from the reentrant circle, and lead to involvement of the right atrium (RA) in a tachycardia (AT) mechanism.
Among 807 patients undergoing atrial fibrillation ablation, PMF was diagnosed in 28 subjects, and AnL was performed in 13, and MI ablation in 15 cases. In 4 (31%) patients, AnL resulted in abrupt AT cycle length prolongation, which was associated with the development of a clockwise biatrial tachycardia (bi-AT). The bi-AT propagated along the lateral and posterior mitral annulus, entered the RA via the coronary sinus, and after activating the RA septum reentered the LA over the Bachmann's bundle. The bi-AT was terminated by ablation in Bachmann's bundle insertion areas in the RA or LA. No bi-AT was documented in the MI group. One patient in the AnL group died of stroke in 10 days following the procedure. Anatomic evaluation showed that at the level of the AnL the RA anteroseptal area was separated from the LA by the aortic root, and was free from ablation damage.
A bi-AT can develop when an AnL is created for PMF termination. Biatrial entrainment mapping facilitates diagnosis. Termination of the bi-AT is feasible when ablated from either RA or LA.
有人提出，连接二尖瓣环与右肺静脉的左心房（LA）前壁消融线（AnL）或房顶线，可作为二尖瓣峡部（MI）消融治疗二尖瓣环周围性心动过速（PMF）的替代方法。从理论上讲，AnL可将左心房间隔壁排除在折返环之外，并导致右心房（RA）参与心动过速（AT）机制。
在807例行房颤消融的患者中，28例诊断为PMF，其中13例行AnL消融，15例行MI消融。4例（31%）患者行AnL消融后出现AT周期长度突然延长，这与顺时针双房性心动过速（双房性AT）的发生有关。双房性AT沿二尖瓣环外侧和后壁传导，经冠状窦进入RA，激活RA间隔后经巴赫曼束重新进入LA。双房性AT在RA或LA的巴赫曼束插入区域消融后终止。MI组未记录到双房性AT。AnL组1例患者在术后10天死于中风。解剖评估显示，在AnL水平，RA前间隔区域被主动脉根部与LA分隔开，未受消融损伤。
为终止PMF而创建AnL时可能会发生双房性AT。双房拖带标测有助于诊断。从RA或LA进行消融时，双房性AT的终止是可行的。
