Catheter ablation of atrioatrial conduction as a cure for atrial arrhythmia after orthotopic heart transplantation.
Catheter ablation of atrioatrial conduction as a cure for atrial arrhythmia after orthotopic heart transplantation.
复制标题
心房传导导管消融可治疗原位心脏移植后的房性心律失常。
DOI：
10.1016/s0735-1097(98)00360-x
复制
发表时间：
1998
影响因子：
24
通讯作者：
A. Cribier
中科院分区：
文献类型：
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作者：
N. Saoudi;M. Redonnet;F. Anselme;H. Poty;A. Cribier
目标。我们报告了三位患者，他们的房性心律失常是通过外科缝合线上的传导消融来治疗的。近些年来，在原位心脏移植后，有关穿过供体和自体右心房缝合线的传导已被报道。在射频消融成功之前，通过标测和起搏移植的右心房和受者的右心房来评估两个心房之间的关系及其与临床心律失常的相关性。例1、例3房室传导为双向。两者在窦性心律时均可观察到两种类型的P波。在病例2中，从受者到移植心房的传导产生了一种非常特殊的房性早搏的体表心电图模式。由于传导阻滞是单向的，受者的房窦性心律不受干扰，表现为房性心律失常。1例采用窦性心律消融，2例采用受体右心房起搏，3例在传导时间最短的部位进行右心房起搏。在成功的消融部位记录到多个成分的电位。分别在1、4、2个射频脉冲后行全房室传导阻断。手术结束时未发生心动过速，后期随访无事件发生。在评估移植心脏的房性心律失常时，应考虑致心律失常房房传导的存在，因为射频导管消融术有可能治愈房性心律失常。
Objectives. We present three patients in whom atrial arrhythmia was treated by ablation of electrical conduction across a surgical suture line.Background. Conduction across the suture line separating the donor and native right atria has recently been described after orthotopic heart transplantation.Methods. Mapping and pacing of both grafted and recipient right atrium was performed to assess the relation between both atria and its relevance to clinical arrhythmia, prior to successful radiofrequency at the site of electrical communication.Results. In cases 1 and 3, atrioatrial conduction was bidirectional. In both, two types of P waves were observed during sinus rhythm. In case 2, conduction from the recipient to the grafted atrium yielded a very particular surface ECG pattern of atrial extrasystole. The block being unidirectional, the recipient atrial sinus rhythm was not perturbed and behaved like an atrial parasystole. Ablation was performed during sinus rhythm in case 1, recipient right atrial pacing in case 2 and grafted right atrial pacing in case 3 at the site with the shortest conduction time to the other tissue. At the successful ablation site multiple component potentials were recorded. Respectively, 1, 4 and 2 radiofrequency pulses were followed by total atrioatrial conduction interruption. No tachycardia could be induced at the end of the procedure and late follow-up was event free.Conclusions. The existence of arrhythmogenic atrioatrial conduction should be taken into account when evaluating atrial arrhythmias in the transplanted heart because it is potentially curable by radiofrequency catheter ablation.
Jap.J.Phrmaco.40。
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