Tracy C M, Swartz J F, Fletcher R D, Hoops H G, Solomon A J, Karasik P E, Mukherjee D
Department of Medicine, Georgetown University Hospital, Washington, D.C. 20007.
J Am Coll Cardiol. 1993 Mar 15;21(4):910-7. doi: 10.1016/0735-1097(93)90346-3.
Although ectopic atrial tachycardia is infrequent, it can be an important clinical challenge. We sought to define an alternative therapeutic approach to this refractory problem.
Radiofrequency energy catheter ablation has been used to treat a variety of ventricular and supraventricular arrhythmias but has not been proved efficacious in the management of ectopic atrial tachycardia.
Ten patients (14 to 47 years of age) referred with refractory ectopic atrial tachycardia were studied. Mapping techniques included identification of earliest atrial activation, confirmation of concordance of P wave configuration during spontaneous tachycardia and pacing from the ablation catheter, and paced activation sequence mapping. The paced activation sequence mapping compared the activation sequence at multiple atrial sites during spontaneous tachycardia with that recorded during pacing from the ablation catheter. The catheter was steered to a point where pacing reproduced the spontaneous activation sequence.
Foci were right atrial in eight patients and left atrial in two. In 8 of 10 patients, 514 +/- 97 (SE) J and 5.7 +/- 2.3 (SD) J radiofrequency energy applications ablated the ectopic focus. Seven of these eight patients presented with one focus and one had two discrete and stable foci. Ablation was unsuccessful in two patients with multiple foci. No complications occurred. An arrhythmia focus recurred in two patients and one patient underwent successful repeat ablation. The other patient was managed medically. All seven patients with successful ablation are symptom free after 6.5 +/- 3.8 months.
Our preliminary experience suggests that with the use of both paced activation sequence mapping and standard techniques, radiofrequency ablation of ectopic atrial tachycardia may be a safe and effective form of therapy.
尽管异位房性心动过速并不常见，但它可能是一个重要的临床挑战。我们试图为这个难治性问题确定一种替代治疗方法。
射频能量导管消融已被用于治疗各种室性和室上性心律失常，但尚未被证明对异位房性心动过速的治疗有效。
对10例（年龄14至47岁）因难治性异位房性心动过速前来就诊的患者进行了研究。标测技术包括确定最早的心房激动、确认自发心动过速期间P波形态的一致性以及从消融导管进行起搏，以及起搏激动顺序标测。起搏激动顺序标测将自发心动过速期间多个心房部位的激动顺序与从消融导管起搏时记录的激动顺序进行比较。将导管引导至起搏能重现自发激动顺序的点。
8例患者的病灶位于右心房，2例位于左心房。在10例患者中的8例，分别应用514±97（标准误）J和5.7±2.3（标准差）J的射频能量消融了异位病灶。这8例患者中有7例有一个病灶，1例有两个离散且稳定的病灶。2例有多病灶的患者消融未成功。未发生并发症。2例患者心律失常病灶复发，1例患者再次成功消融，另1例患者接受药物治疗。所有7例成功消融的患者在6.5±3.8个月后均无症状。
我们的初步经验表明，联合应用起搏激动顺序标测和标准技术，射频消融治疗异位房性心动过速可能是一种安全有效的治疗方式。
