Chen Hongwu, Yang Bing, Ju Weizhu, Zhang Fengxiang, Yang Gang, Gu Kai, Li Mingfang, Liu Hailei, Wang Zidun, Cao Kejiang, Chen Minglong
Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Pacing Clin Electrophysiol. 2017 Aug;40(8):924-931. doi: 10.1111/pace.13099. Epub 2017 Jul 12.
Right atrial tachycardia (AT) is a common arrhythmia postsurgical valve replacement in patients with rheumatic heart disease (RHD). However, the substrate and the mechanism of left AT in such patients and the ablation efficacy is less known.
Twenty-seven RHD patients with AT were enrolled in this study; nine of them (33%) had left AT. Five and four patients had left AT during the first and second procedure, respectively. A spontaneous scar in the left posterior wall was identified in all patients, and obvious anterior scar in three patients. Dual-roof-dependent AT was found in three patients and macroreentry AT surrounding right pulmonary vein was identified in one patient, two of whom had left anterior scar. Three patients had AT circuit going around the mitral annulus, one of whom had left anterior scar. Entrainment pacing at different sites confirmed the mechanism of these macroreentries. Two patients had a focal origin, one was localized in posterior wall at the edge of the scar and the other one was originated from the left septum with normal voltage. After a mean follow-up of 27.4 ± 7.9 months, the left AT group had a similar recurrence rate compared with the right AT group alone (67% vs 56%, P = 0.58). In the left AT group, 11% of patients had AT recurrence and 56% of patients developed atrial fibrillation.
Left atrial AT can occur in RHD patients postmitral valve replacement. Catheter ablation is feasible with high acute success rate. The incidence of late development atrial fibrillation is considerable after successful ablation.
右房性心动过速（AT）是风湿性心脏病（RHD）患者术后瓣膜置换常见的心律失常。然而，此类患者左房性心动过速的基质、机制及消融疗效鲜为人知。
本研究纳入27例RHD合并AT患者，其中9例（33%）为左房性心动过速。首次手术中有5例、第二次手术中有4例发生左房性心动过速。所有患者左后壁均发现自发性瘢痕，3例有明显前壁瘢痕。3例患者发现双房顶依赖型AT，1例患者发现围绕右肺静脉的大折返性AT，其中2例有左前壁瘢痕。3例患者的AT环路围绕二尖瓣环，其中1例有左前壁瘢痕。在不同部位进行拖带起搏证实了这些大折返的机制。2例患者有局灶性起源，1例位于瘢痕边缘的后壁，另1例起源于电压正常的左间隔。平均随访27.4±7.9个月后，左房性心动过速组与单纯右房性心动过速组的复发率相似（67%对56%，P=0.58）。在左房性心动过速组中，11%的患者发生AT复发，56%的患者发生房颤。
二尖瓣置换术后的RHD患者可发生左房性心动过速。导管消融可行，急性成功率高。成功消融后晚期发生房颤的发生率相当高。
