Hijioka Naoko, Kamioka Masashi, Suzuki Hitoshi, Takeishi Yasuchika
Department of Cardiology and Hematology, Fukushima Medical University, Fukushima 960-1295, Japan.
Case Rep Med. 2016;2016:6485939. doi: 10.1155/2016/6485939. Epub 2016 Apr 11.
Introduction. Little is known about the effects of volume change by hemodialysis (HD) and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT) in a patient who had left atrial (LA) scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF) on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery). Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.
引言。关于血液透析（HD）引起的容量变化以及解剖结构与左心房接触所产生的机械应力对心房重构进展的影响，目前所知甚少。我们遇到一例心房心动过速（AT）患者，其左心房（LA）顶部存在左心房瘢痕，且在该心房瘢痕周围有一个传导缓慢的低电压区域，这些构成了AT环路的组成部分。在此，我们提出关于左心房瘢痕和低电压区域形成的可设想假说。我们的观点对于为接受HD治疗的慢性肾衰竭（CRF）患者制定消融策略可能会有所帮助。病例报告。一名接受HD治疗的65岁CRF男性患者因AT消融前来就诊。三维电解剖标测显示，AT以逆时针方向围绕左心房瘢痕传导。在左心房瘢痕上方存在一个缓慢传导区域，在消融过程中AT在此处终止。计算机断层扫描显示左心房与解剖结构（升主动脉和肺动脉）之间存在密切关系。结论。HD引起的容量变化以及解剖结构与左心房的紧密接触可促进心房重构，导致AT的发生。
