Krause Ulrich, Backhoff David, Klehs Sophia, Schneider Heike E, Paul Thomas
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany.
Europace. 2016 Jul;18(7):1055-60. doi: 10.1093/europace/euv295. Epub 2015 Oct 28.
Catheter ablation of atrial re-entrant tachycardia in patients after atrial switch procedure for transposition of the great arteries or with a Fontan circulation is technically challenging if the critical part of the re-entry circuit is located within the pulmonary venous atrium (PVA). We report our experience in transbaffle access (TBA) to the PVA for ablation of atrial re-entrant tachycardia focusing on technical details.
In eight patients, six after Mustard procedure and two with a Fontan circulation, endocardial mapping of atrial re-entrant tachycardia revealed the critical part of the re-entry circuit within the PVA. A total of 10 ablation procedures were performed. Detailed angiographic assessment of the anatomy of the systemic and pulmonary venous atria was performed prior to baffle puncture. Transbaffle access was successfully established with a standard transseptal needle in 9 of 10 procedures. No major complications occurred. At the end of the procedure and the removal of the transseptal sheath, there was no residual shunt in any patient.
Transbaffle access to the PVA for ablation of atrial re-entrant tachycardia is feasible, less invasive than alternative approaches and can be safely applied in patients after Mustard procedure or with a Fontan circulation. However, the rigidity of prosthetic material may preclude baffle puncture at least in a subset of those patients.
对于大动脉转位心房调转术后或采用Fontan循环的患者，如果折返环路的关键部分位于肺静脉心房（PVA）内，导管消融房性折返性心动过速在技术上具有挑战性。我们报告经挡板进入PVA进行房性折返性心动过速消融的经验，重点关注技术细节。
8例患者，6例为Mustard术后，2例采用Fontan循环，房性折返性心动过速的心内膜标测显示折返环路的关键部分位于PVA内。共进行了10次消融手术。在挡板穿刺前对体循环和肺静脉心房的解剖结构进行了详细的血管造影评估。10例手术中有9例通过标准的经房间隔穿刺针成功建立了经挡板进入途径。未发生重大并发症。手术结束并拔除经房间隔鞘管后，所有患者均无残余分流。
经挡板进入PVA进行房性折返性心动过速消融是可行的，比其他方法侵入性小，可安全应用于Mustard术后或采用Fontan循环的患者。然而，假体材料的刚性可能至少在部分此类患者中妨碍挡板穿刺。
