希氏束旁局灶性房性心动过速导管消融策略的比较。
Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region.
机构信息
Mechnikov North-West State Medical University, Saint Petersburg, Russia.
Cardiology Division, University Hospital "S. Maria della Misericordia", Udine, Italy.
出版信息
Heart Rhythm. 2017 Jul;14(7):998-1005. doi: 10.1016/j.hrthm.2017.02.028. Epub 2017 Mar 2.
BACKGROUND
Recent studies have suggested that para-Hisian atrial tachycardia (AT) can be successfully ablated from the right atrium (RA), left atrium (LA), or noncoronary cusp (NCC) in the aorta; however, the best approach remains unclear.
OBJECTIVE
This study aimed to compare different approaches to radiofrequency catheter ablation (RFCA) of para-Hisian AT.
METHODS
We retrospectively analyzed 68 consecutive patients (49[72%] women; mean age 61 ± 13 years) treated with RFCA for this type of AT. Mapping of the RA (n = 68), LA (n = 21), and NCC (n = 52) was performed during AT to identify the earliest activation site and to apply RFCA.
RESULTS
RFCA successfully terminated AT in the RA in 13 of 28 patients (46.4%), in the LA in 4 of 16 patients (25.0%), and in the NCC in 46 of 52 patients (88.5%) after 1 procedure (P < .05). Atrioventricular block occurred only during RFCA in the RA in 4 of 28 patients (14.3%). After a mean follow-up of 33.5 ± 25.4 months, AT recurrence was observed in 5 of 13 patients (38.5%) ablated in the RA, 1 of 4 (25.0%) ablated in the LA, and 2 of 46 (4.4%) ablated in the NCC (P < .05). RFCA in the LA was effective only if the local activation time (LAT) was earlier than that in the RA. RFCA in the NCC was successful regardless of the LAT (P < .05).
CONCLUSION
Mapping and ablation in the NCC should be always considered in cases of AT originating from the His bundle region, regardless of the LAT.
背景
最近的研究表明，旁希氏房性心动过速（AT）可以从右心房（RA）、左心房（LA）或主动脉非冠状动脉瓣（NCC）成功消融；然而，最佳方法仍不清楚。
目的
本研究旨在比较射频导管消融（RFCA）治疗旁希氏 AT 的不同方法。
方法
我们回顾性分析了 68 例接受 RFCA 治疗的此类 AT 患者（49 例[72%]为女性；平均年龄 61±13 岁）。在 AT 期间对 RA（n=68）、LA（n=21）和 NCC（n=52）进行了映射，以确定最早的激活部位并进行 RFCA。
结果
在 28 例患者中，13 例（46.4%）在 RA 中、4 例（25.0%）在 LA 中、52 例患者中的 46 例（88.5%）在一次手术中成功终止了 AT（P<0.05）。仅在 RA 中进行 RFCA 时，4 例（14.3%）患者出现房室传导阻滞。在平均 33.5±25.4 个月的随访后，在 RA 消融的 13 例患者中，5 例（38.5%）出现 AT 复发，LA 消融的 4 例患者中，1 例（25.0%）出现 AT 复发，NCC 消融的 46 例患者中，2 例（4.4%）出现 AT 复发（P<0.05）。只有当局部激活时间（LAT）早于 RA 时，LA 中的 RFCA 才有效。无论 LAT 如何，NCC 中的 RFCA 均成功（P<0.05）。
结论
无论 LAT 如何，对于起源于希氏束区域的 AT，都应始终考虑在 NCC 进行映射和消融。
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