Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China.
The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Heart Rhythm. 2020 Dec;17(12):2135-2144. doi: 10.1016/j.hrthm.2020.06.031. Epub 2020 Jun 30.
Macroreentrant biatrial tachycardia (BiAT) associated with interatrial septal incisions after mitral valve (MV) surgery has been rarely reported.
The purpose of this study was to assess the mapping and ablation strategy of this special category of atrial tachycardia (AT).
We identified 10 BiATs from a total of 84 ATs after MV surgery performed at 3 institutions. Activation maps for both the right atrium (RA) and left atrium (LA) were obtained using an ultrahigh-density mapping system. We also performed entrainment pacing from multiple LA and RA site within the speculative circuit.
By analyzing activation and propagation maps of both atria, we classified the circuit into 3 distinct types. In all types, posteroinferior interatrial connections act as a critical limb that, combined with other interatrial connections (Bachmann bundle, fossa ovalis, and coronary sinus ostium in 3 types, respectively), complete the circuit of BiATs. Most ATs (8/10) were terminated targeting the RA and LA end of posteroinferior interatrial connection sites.
Ultrahigh-density mapping provides a detailed description of the macroreentrant circuit of BiAT associated with interatrial septal incisions. Posteroinferior interatrial connections were essential for the circuit and should be the preferred target for ablation.
二尖瓣（MV）手术后，与房间隔切开相关的大折返双心房心动过速（BiAT）很少有报道。
本研究旨在评估这一特殊类型房性心动过速（AT）的标测和消融策略。
我们在 3 家机构共 84 例 MV 手术后的 AT 中，确定了 10 例 BiAT。使用超高密度标测系统获得右心房（RA）和左心房（LA）的激活图。我们还在推测的环路上的多个 LA 和 RA 部位进行了拖带起搏。
通过分析双心房的激活和传播图，我们将环路由 3 种不同类型。在所有类型中，后下房间连接作为一个关键的分支，与其他房间连接（Bachmann 束、卵圆窝、和冠状窦口在 3 种类型中分别为）一起，完成 BiAT 的环。大多数 AT（8/10）在 RA 和 LA 结束时终止，靶点在后下房间连接部位。
超高密度标测提供了与房间隔切开相关的 BiAT 的大折返环的详细描述。后下房间连接对环至关重要，应作为消融的首选靶点。
