Wang Hao, Xi Siqi, Chen Jindong, Gan Tian, Huang Weiye, He Ben, Zhao Liang
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200003, China.
Cardiac Electrophysiology Department, Boston Scientific Company, Shanghai 200023, China.
J Cardiovasc Dev Dis. 2022 Aug 5;9(8):249. doi: 10.3390/jcdd9080249.
The mechanisms of atrial tachycardia (AT) related to the left atrial anterior wall (LAAW) are complex and can be challenging to map in patients after catheter ablation for atrial fibrillation (AF) or cardiac surgery. We aimed to investigate the electrophysiological characteristics AT and to devise an ablation strategy. We identified 31 scar-related LAAW reentrant ATs in 22 patients after catheter ablation for AF or cardiac surgery. Activation maps of the left atrium (LA) or both atria were obtained using a high-density mapping system, and the precise mechanism and critical area for each AT were analyzed. Patients were followed up regularly in a clinic. After analyzing the activation and propagation of each AT, the scar-related LAAW ATs were classified into three types, based on mechanisms related to: (1) LAAW conduction gap(s) in 19 LA macro-reentrant ATs; (2) LAAW epicardial connection(s) in 11 LA or bi-atrial ATs; and (3) LAAW local micro-reentry in 1 LAAW AT. Multiple ATs were identified in seven patients. Effective ablation (termination or circuit change of AT) was obtained in 30 ATs by targeting the critical area identified by the mapping system. During 16.0 ± 7.6 months follow-up, recurrent AT occurred in two patients. Three mechanisms of scar-related AT of LAAW were identified, most of which were related to LAAW conduction gaps. Notably, epicardial AT or bi-atrial AT comprised a nonnegligible proportion. A high-density mapping system could make it possible to determine the accurate mechanism of AT and serve as a guide following ablation.
与左心房前壁(LAAW)相关的房性心动过速(AT)机制复杂,对于接受过房颤(AF)导管消融或心脏手术的患者而言,其标测颇具挑战性。我们旨在研究AT的电生理特征并制定消融策略。我们在22例接受过AF导管消融或心脏手术的患者中识别出31例与瘢痕相关的LAAW折返性AT。使用高密度标测系统获取左心房(LA)或双心房的激动标测图,并分析每个AT的精确机制和关键区域。患者在门诊定期随访。在分析每个AT的激动和传导情况后,根据相关机制将与瘢痕相关的LAAW AT分为三种类型:(1)19例LA大折返性AT中的LAAW传导间隙;(2)11例LA或双心房AT中的LAAW心外膜连接;(3)1例LAAW AT中的LAAW局部微折返。7例患者中识别出多个AT。通过靶向标测系统识别出的关键区域,30例AT实现了有效消融(AT终止或电路改变)。在16.0±7.6个月的随访期间,2例患者出现AT复发。确定了与瘢痕相关的LAAW AT的三种机制,其中大多数与LAAW传导间隙有关。值得注意的是,心外膜AT或双心房AT占不可忽视的比例。高密度标测系统能够确定AT的准确机制,并在消融后提供指导。