Seals A A, Lawrie G M, Magro S, Lin H T, Pacifico A, Roberts R, Wyndham C R
Department of Medicine, Methodist Hospital, Baylor College of Medicine, Houston, Texas 77030.
J Am Coll Cardiol. 1988 May;11(5):1111-7. doi: 10.1016/s0735-1097(98)90072-9.
Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focal tachycardia was reproduced during electrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients. Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence. In all four patients after right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia after epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 months (mean 30). It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.
虽然已有儿童房性局灶性心动过速手术治疗成功的报道，但成人该心律失常的外科治疗仅有个别报告。在这个包含8例耐药性右房局灶性心动过速患者（年龄10至53岁）的病例系列中，描述了电生理研究结果、手术技术及长期随访情况。电生理研究期间再现了房性局灶性心动过速，心内膜标测确定了所有患者右房最早的心房激动起始部位。心外膜标测证实了8例术中可诱发心动过速患者中7例的房性心动过速病灶位置。仅接受心外膜冷冻消融治疗的4例患者中，2例出现心动过速复发，需要再次手术。目前均无心律失常复发。在所有4例接受右房切除术的患者中（其中2例仅在心外膜冷冻消融术后术中出现房性局灶性心动过速复发），在11至67个月（平均30个月）的临床随访期内均未复发。结论是，对于成年患者：1）通过心内膜和心外膜标测的电生理研究可成功进行房性局灶性心动过速的手术治疗；2）仅心外膜冷冻消融可能在术中或术后与房性局灶性心动过速复发相关；3）右房次全切除术似乎是一种耐受性良好的手术，房性局灶性心动过速无长期复发。
