Clinical experience with electroanatomic mapping of ectopic atrial tachycardia
Clinical experience with electroanatomic mapping of ectopic atrial tachycardia
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DOI：
10.1046/j.1460-9592.2002.00049.x
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发表时间：
2002-01-01
影响因子：
1.8
通讯作者：
Steinbeck, G
中科院分区：
文献类型：
--
作者：
Hoffmann, E;Reitmann, C;Steinbeck, G
本研究的目的是评估一种新的三维定位系统作为导管消融治疗异位房性心动过速的指导的临床应用。采用电解剖定位系统CARTO对42例连续的药物难治性异位房性心动过速患者进行了前瞻性观察性研究。致心律失常病灶30例在右心房，12例在左心房。42例连续异位房性心动过速患者中有37例可以建立完整的右心房或左心房电解剖图。右房性心动过速右心房包括近端冠状窦的平均激活时间为94±25 ms；左房性心动过速时左房激活时间为86±17 Ms。右房性心动过速的平均定位时间为30分钟，左房性心动过速的平均定位时间为22分钟，分别允许收集86 +/- 50和65 +/- 28个导管位置。电解剖图计算出的最早心房激活面积在右房性心动过速组为0.6 +/- 0.4 cm(2)，在左房性心动过速组为1.0 +/- 0.9 cm(2)。30例患者中33个致心律失常灶最常见的位置为右心房上外侧或中外侧（n = 10）和靠近冠状窦口的缝间区（n = 7）。异位左试灶最常位于靠近二尖瓣环的下方位置（n = 5）和靠近肺静脉口的位置（n = 4）。双房电解剖图显示左房心动过速时在高房间隔或冠状窦口附近最早的右房活动。导管消融在85%的右房性心动过速和82%的左房性心动过速中成功。在异位房性心动过速患者中，电解剖标测是一种安全可行的技术，可以在精确的心房解剖重建中实现自动聚焦的三维可视化。这种新颖的定位技术有助于导管消融复杂异位房性心动过速。
The aim of this study was to evaluate the clinical use of a new three-dimensional mapping system as a guide for catheter ablation of ectopic atrial tachycardia. A series of 42 consecutive patients with drug refractory ectopic atrial tachycardia was studied in a prospective observational trial with the electroanatomic mapping system CARTO. The arrhythmogenic focus was found in the right atrium in 30 patients and in the left atrium in 12 patients. The construction of a complete electroanatomic map of the right or left atrium was possible in 37 of 42 consecutive patients with ectopic atrial tachycardia. Mean activation time of the right atrium, including the proximal coronary sinus, was 94 +/- 25 ms for right atrial tachycardias; left atrial activation time during left atrial tachycardias was 86 +/- 17 ms. Average mapping time was 30 minutes for right atrial tachycardias and 22 minutesfor left atrial tachycardias, allowing the collection of 86 +/- 50 and 65 +/- 28 catheter positions, respectively. The size of the area of earliest atrial activation calculated from the electroanatomic map amounted to 0.6 +/- 0.4 cm(2) in right atrial tachycardias and 1.0 +/- 0.9 cm(2) in left atrial tachycardias, In the right atrium the most common locations of the 33 arrhythmogenic foci in 30 patients were the high or mid-lateral right atrium (n = 10) and the inferoporaseptal region near the coronary sinus ostium (n = 7). Ectopic left a trial foci were most commonly located in an inferior position near the mitral annulus (n = 5) and in proximity to the ostium of the pulmonary veins (n = 4). Biatrial electroanatomic mapping allowed visualization of earliest right atrial activation during left atrial tachycardia at the high interatrial septum or near the coronary sinus ostium. Catheter ablation was successful in 85% of right atrial tachycardias and 82% of left atrial tachycardias. In patients with ectopic atrial tachycardia electroanatomic mapping is a safe and feasible technique that allows three-dimensional visualization of the automatic focus in a precise anatomic reconstruction of the atria. This novel mapping, technology facilitates catheter ablation of complex ectopic atrial tachycardia.