Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China.
Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, China.
Heart Rhythm. 2024 Oct;21(10):1853-1866. doi: 10.1016/j.hrthm.2024.03.1819. Epub 2024 Apr 9.
Different types of recurrent atrial tachycardia (AT) after Cox-maze procedures have been reported, whereas biatrial tachycardia (BiAT) has not been systematically analyzed.
In this study, we retrospectively investigated the electrophysiologic characteristics of BiAT after Cox-maze procedures by use of an ultrahigh-density mapping system.
Of a consecutive 76 patients who underwent catheter ablation of AT after Cox-maze procedures, 12 BiATs were identified. High-density activation mapping was performed in both the left atrium and right atrium in combination with entrainment pacing to confirm the circuit.
We classified these BiATs into 2 groups. In group 1 (7 patients), the bidirectional block of maze linear lesions to prevent the macroreentrant AT was achieved; the posterior interatrial connections were involved in the circuit. In group 2 (5 patients), the bidirectional block of maze linear lesions was not blocked, and the most common gap was located at the end of the linear lesion near the annulus. In group 1, all the ATs were terminated by targeting the corresponding left atrium end of the posterior interatrial connections. In group 2, the ATs were terminated by targeting the gap near the annulus.
The optimal ablation strategy for BiATs after the maze procedure should be based on detailed demonstration of the circuit by high-density mapping.
Cox 迷宫手术后出现了不同类型的复发性房性心动过速（AT），但并未对双心房心动过速（BiAT）进行系统分析。
本研究通过超高密度标测系统对 Cox 迷宫手术后的 BiAT 的电生理特征进行回顾性研究。
连续 76 例行导管消融治疗 Cox 迷宫手术后 AT 的患者中，发现 12 例 BiAT。在左心房和右心房均进行高密度激动标测，并结合拖带起搏以确认环路。
我们将这些 BiAT 分为 2 组。在组 1（7 例）中，通过迷宫线性病变的双向阻滞来防止宏观折返性 AT 的形成，涉及到房间隔后连接。在组 2（5 例）中，迷宫线性病变的双向阻滞未被阻断，最常见的间隙位于靠近环的线性病变末端。在组 1 中，所有 AT 均通过靶向相应的房间隔后连接的左心房末端而终止。在组 2 中，通过靶向靠近环的间隙而终止 AT。
对于迷宫手术后的 BiAT，应基于高密度标测详细展示环路来制定最佳消融策略。
