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既往有肺静脉隔离术的患者出现左侧大折返性心动过速或右侧局灶性心动过速：两个心房的故事

Left-sided Macro-reentry or Right-sided Focal Tachycardia in Patients with Prior Pulmonary Vein Isolation: A Tale of Two Atria.

作者信息

Kanjwal Khalil, Kichloo Asim, Mohiuddin Mir Khalid, Haji Abdul Qadir

机构信息

Department of Electrophysiology, McLaren Greater Lansing Hospital, Lansing, MI, USA.

Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA.

出版信息

J Innov Card Rhythm Manag. 2021 Nov 15;12(11):4764-4768. doi: 10.19102/icrm.2021.121104. eCollection 2021 Nov.

DOI:10.19102/icrm.2021.121104
PMID:34858670
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8631371/
Abstract

We report on three patients with prior pulmonary vein isolation who presented with atrial tachycardia/atrial flutter. During electrophysiology study, the whole tachycardia cycle length was mapped to the left atrium. Multiple ablation attempts failed to terminate the tachycardia and, subsequently, right atrial mapping revealed a focal early site of origin near the superior vena cava-right atrial junction in two patients and outside the coronary sinus ostium in one patient. In this report, we discuss the probable mechanism of these tachycardias.

摘要

我们报告了3例既往有肺静脉隔离术的患者，他们出现了房性心动过速/心房扑动。在电生理研究期间，整个心动过速周期长度被标测到左心房。多次消融尝试未能终止心动过速，随后，右心房标测显示，2例患者在靠近上腔静脉-右心房交界处有一个局灶性早期起源部位，1例患者在冠状窦口外有一个局灶性早期起源部位。在本报告中，我们讨论了这些心动过速的可能机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/a50fe88fa446/icrm-12-4764-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/56a127df254b/icrm-12-4764-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/1b2552d6aefb/icrm-12-4764-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/a50fe88fa446/icrm-12-4764-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/56a127df254b/icrm-12-4764-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/1b2552d6aefb/icrm-12-4764-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d702/8631371/a50fe88fa446/icrm-12-4764-g003.jpg

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本文引用的文献

1
Characterization of atrial flutter after pulmonary vein isolation by cryoballoon ablation.冷冻球囊消融治疗肺静脉隔离后心房扑动的特征。
J Interv Card Electrophysiol. 2020 Mar;57(2):233-240. doi: 10.1007/s10840-019-00560-9. Epub 2019 May 17.
2
Catheter ablation of atypical flutter using new 3-dimensional electroanatomic mapping software focusing on areas of conduction block.使用专注于传导阻滞区域的新型三维电解剖标测软件对非典型心房扑动进行导管消融。
HeartRhythm Case Rep. 2019 Jan 14;5(4):225-228. doi: 10.1016/j.hrcr.2019.01.003. eCollection 2019 Apr.
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Ablation Lesion Characterization in Scarred Substrate Assessed Using Cardiac Magnetic Resonance.
应用心脏磁共振评估瘢痕基质中的消融损伤特征。
JACC Clin Electrophysiol. 2019 Jan;5(1):91-100. doi: 10.1016/j.jacep.2018.11.001. Epub 2018 Dec 26.
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Biatrial Tachycardia: Distinguishing Between Active and Passive Activation.双房性心动过速：区分主动激活和被动激活
Circ Arrhythm Electrophysiol. 2016 May;9(5):e003175. doi: 10.1161/CIRCEP.115.003175.
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A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.根据电生理机制和解剖学基础对心房扑动和规则性房性心动过速进行的分类；欧洲心脏病学会心律失常工作组和北美起搏与电生理学会联合专家组声明
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6
Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms, and effects of radiofrequency ablation.成年患者的持续性房性心动过速。电生理特征、药理反应、可能机制及射频消融的效果
Circulation. 1994 Sep;90(3):1262-78. doi: 10.1161/01.cir.90.3.1262.