Characterization of reentrant circuits in left atrial macroreentrant tachycardia -: Critical isthmus block can prevent atrial tachycardia recurrence
Characterization of reentrant circuits in left atrial macroreentrant tachycardia -: Critical isthmus block can prevent atrial tachycardia recurrence
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DOI：
10.1161/01.cir.0000015077.12680.2e
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发表时间：
2002-04-23
期刊：
影响因子：
37.8
通讯作者：
Kuck, KH
中科院分区：
文献类型：
--
作者：
Ouyang, FF;Ernst, S;Kuck, KH
背景左心房大折返性心动过速（LAMRT）尚未被characterized in detail.Methods和Results-28例LAMRT患者，包括4例消融典型心房扑动（AFL），在1999年2月至2001年10月期间进行了左心房（LA）的电解剖标测。26例患者在LAMRT期间进行了LA标测，2例患者在窦性心律期间进行了LA标测。电沉默区或连续线的双电位被确定为获得性的解剖障碍，在所有患者。在23/26例LAMRT标测的患者中，识别出42个具有受保护峡部的折返回路。峡部宽11.8 ± 5.9 mm，最大振幅为0.07 - 3.61 mV。放射性脉冲终止了23例患者的所有LAMRT，并导致20例患者的峡部传导阻滞。在2例窦标测患者中，所有确定的峡部均被消融。此外，6例患者诱导并消融了AFL。4例患者房性心动过速复发：3例峡部无有效阻滞的患者出现相同LAMRT复发，1例三尖瓣环峡部无消融的患者出现AFL。所有心动过速均在第二次手术中消除。25例患者的峡部，20例患者没有房性心律失常和5只心房颤动在一个中位数随访14 months.Conclusion-the折返回路与保护峡部可以确定在89%的患者LAMRT通过电解剖标测。大多数患者的峡部适合射频应用。所有峡部阻滞患者均无房性心动过速复发。
Background-Left atrial macroreentrant tachycardia (LAMRT) has not been characterized in detail.Methods and Results-Twenty-eight patients with LAMRT, including 4 patients with ablated typical atrial flutter (AFL), underwent electroanatomic mapping of the left atrium (LA) between February 1999 and October 2001. LA maps were performed during LAMRT in 26 patients and during sinus rhythm in 2 patients. Electrically silent areas or continuous lines of double potentials were identified as acquired anatomic barriers in all patients. In 23 of 26 patients with LAMRT mapping, 42 reentry circuits with a protected isthmus were identified. The isthmus was 11.8 +/- 5.9 mm. wide, with the maximal amplitude of 0.07 to 3.61 mV. Radiofrequency pulses terminated all LAMRTs in 23 patients and resulted in conduction block across the isthmus in 20 patients. In 2 patients with sinus mapping, all identified isthmuses were ablated. Additionally, AFL was induced and ablated in 6 patients. Atrial tachycardia recurred in 4 patients: 3 patients without validated block across the isthmus presented with recurrence of the same LAMRT, and 1 patient without ablated cavotricuspid isthmus presented with AFL. All tachycardias were abolished during a second procedure. Of 25 patients with identified isthmuses, 20 patients were without atrial arrhythmia and 5 had only atrial fibrillation during a median follow-up of 14 months.Conclusion-The reentry circuit with a protected isthmus can be identified in 89% patients with LAMRT by electroanatomic mapping. The isthmuses were amenable to radiofrequency applications in most patients. No atrial tachycardia recurred in any patients with isthmus block.