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目的探讨三维电磁导管标测系统(Carto)指导导管射频消融治疗局灶性房性快速心律失常(简称房速)的临床价值。方法我院2007年4月至2009年4月共13例房速患者接受治疗,男性7例,女性6例,年龄(42.2±10.2)岁,其中3例为常规消融失败患者。对所有患者应用Carto标测实时重建房速发作时三维电激动图,判断房速起源部位及类型,采用冷盐水灌注导管在最早激动点或关键峡部消融。结果13例房速均为局灶性房速,12例消融成功,1例右心耳体部房速消融失败。7例房速在希氏束或冠状静脉窦(CS)近端记录到显著提前的A波,电解剖标测和消融证实房速起源于上腔静脉口部3例、右心耳体部1例、CS口部及其附近3例。3例房速在CS电极远端记录到明显提前的A波,消融结果证实房速起源于左心耳后壁1例、左上肺静脉开口部2例。3例房速在希氏束和CS近端记录到相对提前的A波,消融证实房速起源于右下肺静脉口部2例、主动脉无冠窦内1例。随访2～24个月,其中1例术后3周复发,再次消融成功。3例术前显著右心扩大者,术后3个月内2例心脏大小恢复正常,1例心脏无显著变化。结论Carto标测房速起源及类型准确快速,能安全、有效指导消融,提高成功率,特别对常规方法消融失败者很有帮助。
Objective To investigate the clinical value of Carto catheterization guided radiofrequency ablation in the treatment of focal atrial tachyarrhythmia (referred to as atrial tachycardia). Methods A total of 13 patients with atrial tachycardia were treated in our hospital from April 2007 to April 2009. There were 7 males and 6 females with a mean age of (42.2 ± 10.2) years. Three of them were routine ablation failures. Real-time reconstruction of atrial tachycardia at Cartesian mapping was performed in all patients to determine the site and type of tachycardia. The cold saline infusion catheter was used to ablate the earliest activation point or critical isthmus. Results All of the 13 cases had atrial tachycardia velocity, and 12 cases had successful ablation. Atrial ablation of right atrial appendage failed. Seven cases of atrial tachycardia or sigmoid sinus (CS) recorded a markedly advanced A wave in the proximal direction. Electroanatomical measurements and ablation confirmed that the tachycardia originated in the superior vena cava in 3 cases and in the right atrial appendage in 1 case , CS mouth and its vicinity in 3 cases. 3 cases of atrial tachycardia were recorded in the CS electrode far ahead of the obvious A wave ablation results confirmed that the atrial tachycardia originated in the left atrial appendage in 1 case, the left upper pulmonary vein in 2 cases. Three cases of Atrial Stenosis recorded a relatively advanced A-wave in His bundle and CS proximal ablation. The ablation confirmed that atrial tachycardia originated in the mouth of the right lower pulmonary vein in 2 cases and in the aorta without coronary sinus. All cases were followed up for 2 to 24 months. One of the patients recurred 3 weeks after operation and successfully ablated again. Three patients with significant right ventricular enlargement preoperatively, 3 cases within 3 months after the resumption of heart size, normal heart no change. Conclusion The accurate and rapid rate of origin and type of Carto test room can guide the ablation safely and effectively and improve the success rate. It is especially helpful for the abortion failure of conventional methods.