Department of Cardiovascular Medicine, University of Fukui, Fukui, Japan.
Department of Cardiovascular Medicine, University of Fukui, Fukui, Japan.
Heart Rhythm. 2021 Feb;18(2):189-198. doi: 10.1016/j.hrthm.2020.09.016. Epub 2020 Sep 30.
Perimitral atrial tachycardias (PMATs) are common atrial tachycardias (ATs), yet their mechanisms vary.
The purpose of this study was to characterize clinical spontaneous PMATs using an ultra-high-resolution (UHR) mapping system.
The study included 32 consecutive PMATs in 31 patients who had undergone AT mapping/ablation using a UHR mapping system.
Six, 10, 11, and 5 PMATs occurred in cardiac intervention-naïve (group A), post-lateral/posterior mitral isthmus linear ablation (group B), post-atrial fibrillation ablation without mitral isthmus linear ablation (group C), and post-cardiac surgery (group D) patients, respectively. Group A patients tended to be older, more likely were female, and had sinus node or atrioventricular conduction disturbances more frequently. A 12-lead synchronous isoelectric interval was observed in 15 PMATs (46.9%). Coronary sinus activation was proximal to distal or distal to proximal except in 3 PMATs with straight patterns due to epicardial gaps. Left atrial anterior/septal wall (LAASW) low-voltage areas were smallest in group B. Slow conduction areas (SCAs) were identified in 26 PMATs (81.2%) and were located on the LAASW in all group A and group D patients. Conduction velocity in the SCAs was slowest in group B. In group B, all PMATs were terminated by single applications, and the gaps were located epicardially in 5 of 10 (50%). Anterior (n = 23) or lateral/posterior (n = 9) mitral isthmus linear block was successfully created without any complications in all. Twenty-five concomitant ATs among 18 patients (58.1%) also were eliminated. During a median of 20.0 (11.0-40.0) months of follow-up, 28 patients (90.3%) were free from any atrial tachyarrhythmias.
An UHR mapping-guided approach with identification of the individual tachycardia mechanism should be the preferred strategy given the distinct and complex arrhythmia mechanisms.
围绕二尖瓣环的房性心动过速（PMAT）是常见的房性心动过速（AT），但其机制各异。
本研究旨在使用超高分辨率（UHR）标测系统对临床自发性 PMAT 进行特征描述。
该研究纳入了 31 例接受 UHR 标测/消融治疗的 PMAT 患者，共 32 例 PMAT。
6、10、11 和 5 例 PMAT 分别发生于心脏介入治疗初发（A 组）、后外侧/后二尖瓣峡部线性消融（B 组）、房颤消融后无二尖瓣峡部线性消融（C 组）和心脏手术后（D 组）患者。A 组患者年龄较大，女性较多，窦房结或房室传导障碍更常见。15 例 PMAT（46.9%）观察到 12 导联等电间隔。除 3 例由于心外膜间隙存在而呈直线模式的 PMAT 外，其余均为心大静脉近端至远端或远端至近端激活。左房前/间隔壁（LAASW）低电压区在 B 组最小。26 例 PMAT（81.2%）发现慢传导区（SCA），所有 A 组和 D 组患者均位于 LAASW。B 组 SCA 中的传导速度最慢。B 组中，所有 PMAT 均单次消融终止，10 例（50%）中的间隙位于心外膜。所有患者均成功建立前（n = 23）或侧/后（n = 9）二尖瓣峡部线性阻滞，无任何并发症。18 例患者（58.1%）中共有 25 例同时存在其他房性心动过速也被消除。中位随访 20.0（11.0-40.0）个月，28 例患者（90.3%）无任何房性快速心律失常。
鉴于不同且复杂的心律失常机制，使用 UHR 标测指导下识别个体心动过速机制应作为首选策略。
