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心房纤维化瘢痕匀化术改善心房颤动消融术后的房间内传导延迟。

Improved intra-atrial conduction delay after successful ablation for atrial fibrillation by scar homogenization in right atrium.

机构信息

Cardiology Division, Gachon University Gil Medical Center, Incheon, Korea.

Cardiology Division, Korea University Anam Hospital, Seoul, Korea.

出版信息

Ann Noninvasive Electrocardiol. 2023 Nov;28(6):e13091. doi: 10.1111/anec.13091. Epub 2023 Oct 2.

DOI:10.1111/anec.13091
PMID:37786276
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10646382/
Abstract

Atrial fibrosis in the right atrium (RA) presenting as a low-voltage zone might be the mechanism of atrial fibrillation (AF) and intra-atrial conduction delay. The impact of scar homogenization in RA on intra-atrial conduction delay is unknown. We describe a patient with paroxysmal AF and significant intra-atrial conduction delay with repetitive atrial flutter, triggered from the lateral free wall in the RA between the significant low-voltage zone and slow conduction area after pulmonary vein isolation. Linear ablation along the trabeculated lateral free wall in the RA to homogenize the scar was successfully performed, and the intra-atrial conduction delay improved ultimately.

摘要

右心房（RA）的心房纤维化呈现为低电压区，可能是心房颤动（AF）和房内传导延迟的机制。RA 内瘢痕匀化对房内传导延迟的影响尚不清楚。我们描述了一例阵发性 AF 患者，在肺静脉隔离后，RA 中显著的低电压区和缓慢传导区之间的外侧游离壁出现反复房性心动过速，触发了显著的房内传导延迟。RA 中沿小梁化外侧游离壁进行线性消融以均匀化瘢痕，最终改善了房内传导延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/18fbc2d4869c/ANEC-28-e13091-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/32652f216b6a/ANEC-28-e13091-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/68df34088c81/ANEC-28-e13091-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/18fbc2d4869c/ANEC-28-e13091-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/32652f216b6a/ANEC-28-e13091-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/68df34088c81/ANEC-28-e13091-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b65/10646382/18fbc2d4869c/ANEC-28-e13091-g004.jpg

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本文引用的文献

1
Right atrial collision time (RACT): A novel marker of propensity for typical atrial flutter.右房碰撞时间（RACT）：一种预测典型房扑倾向的新标志物。
J Cardiovasc Electrophysiol. 2023 Jun;34(6):1377-1383. doi: 10.1111/jce.15935. Epub 2023 May 24.
2
Extensive right atrial free wall low-voltage zone as the substrate for atrial fibrillation: successful ablation by scar homogenization.广泛的右房游离壁低电压区作为房颤的基质：通过瘢痕匀化实现成功消融。
Europace. 2021 Jan 27;23(1):59-64. doi: 10.1093/europace/euaa233.
3
Scar Homogenization in Atrial Fibrillation Ablation: Evolution and Practice.
心房颤动消融中的瘢痕均质化：演变与实践
J Atr Fibrillation. 2017 Oct 31;10(3):1645. doi: 10.4022/jafib.1645. eCollection 2017 Oct-Nov.
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The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.心房颤动的临床特征和病理生理学：临床特征、流行病学和机制之间的关系。
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Atrial remodeling and atrial fibrillation: recent advances and translational perspectives.心房重构与心房颤动：最新进展及转化医学视角。
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6
The spatial distribution of atrial fibrillation termination sites in the right atrium during complex fractionated atrial electrograms-guided ablation in patients with persistent atrial fibrillation.在持续性心房颤动患者中，复杂碎裂心房电图指导下消融时右心房内心房颤动终止部位的空间分布。
J Cardiovasc Electrophysiol. 2013 Sep;24(9):949-57. doi: 10.1111/jce.12187. Epub 2013 Jun 17.
7
Right atrial tachycardias related to regions of low-voltage myocardium in patients without prior cardiac surgery: catheter ablation and follow-up results.与未经心脏手术的患者低电压心肌区域相关的右房性心动过速：导管消融及随访结果。
Europace. 2013 Nov;15(11):1642-50. doi: 10.1093/europace/eut056. Epub 2013 Apr 5.
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J Cardiovasc Electrophysiol. 2012 Oct;23(10):1051-8. doi: 10.1111/j.1540-8167.2012.02370.x. Epub 2012 Aug 7.
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High-resolution analysis of the surface P wave as a measure of atrial electrophysiological substrate.作为心房电生理基质指标的体表P波高分辨率分析。
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Jpn Heart J. 2001 Sep;42(5):575-84. doi: 10.1536/jhj.42.575.