Itoh Taihei, Yoshida Yukihiko, Morishima Itsuro, Yamada Takumi
Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, Birmingham, AL, 35294-0019, USA.
Department of Cardiology, Nagoya Dai-ni Red Cross Hospital, Nagoya, Japan.
J Interv Card Electrophysiol. 2018 Jul;52(2):237-245. doi: 10.1007/s10840-018-0359-6. Epub 2018 Mar 22.
Focal atrial tachycardias (ATs) from the septal cavotricuspid isthmus (CTI) occurring after successful CTI ablation can mimic typical atrial flutter (tAFL). This study investigated the incidence, and electrocardiographic and electrophysiological characteristics of these ATs.
Among 1082 consecutive patients undergoing successful CTI ablation without any congenital heart diseases, 7 were diagnosed with focal ATs originating from the septal CTI that occurred a median of 74 days after the CTI ablation.
The electrocardiographic characteristics of the ATs were similar to those of the tAFLs. The AT's cycle length was never shorter than and often similar to that of tAFLs. The activation patterns along the tricuspid annulus during the ATs were the same as those of tAFLs in 4 patients with foci adjacent to the CTI line, and centrifugal from foci around the coronary sinus (CS) ostium in 3. Entrainment pacing from the lateral CTI during the ATs revealed a manifest fusion and long post-pacing interval. Entrainment pacing from the lateral CTI during the ATs revealed that the atrial electrograms recorded from the CS and high-lateral right atrium were orthodromically captured, while that from the proximal CS revealed that the atrial electrograms recorded from the CS and lateral right atrium were antidromically captured without manifest fusion.
Focal intra-CTI ATs with a microreentrant mechanism very rarely occurred after successful CTI ablation. The electrocardiographic and electrophysiological characteristics of these ATs were similar to those of tAFLs. Overdrive pacing from the lateral CTI and proximal CS was helpful for distinguishing these ATs from recurrent tAFLs.
在成功进行三尖瓣峡部（CTI）消融术后，起源于间隔CTI的局灶性房性心动过速（ATs）可酷似典型房扑（tAFL）。本研究调查了这些ATs的发生率、心电图及电生理特征。
在1082例连续成功接受CTI消融且无任何先天性心脏病的患者中，7例被诊断为起源于间隔CTI的局灶性ATs，发生于CTI消融术后中位数74天。
ATs的心电图特征与tAFLs相似。ATs的周长从不短于tAFLs，且常与之相似。4例病灶邻近CTI线的患者，ATs期间沿三尖瓣环的激动模式与tAFLs相同；3例患者的激动模式是从冠状窦（CS）口周围的病灶呈离心性。ATs期间从外侧CTI进行拖带起搏显示明显融合及长的起搏后间期。ATs期间从外侧CTI进行拖带起搏显示，从CS和高位右房记录到的心房电图为顺向激动捕获，而从近端CS记录到的心房电图显示，从CS和右房外侧记录到的心房电图为逆向激动捕获且无明显融合。
成功进行CTI消融术后，具有微折返机制的心内CTI局灶性ATs非常罕见。这些ATs的心电图和电生理特征与tAFLs相似。从外侧CTI和近端CS进行超速起搏有助于将这些ATs与复发性tAFLs区分开来。
