Surgical treatment of right atrial focal tachycardia in adults.
Surgical treatment of right atrial focal tachycardia in adults.
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成人右心房局灶性心动过速的手术治疗。
DOI：
10.1016/s0735-1097(98)90072-9
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发表时间：
1988
影响因子：
24
通讯作者：
Wyndham,CR
中科院分区：
文献类型：
--
作者：
Seals,AA;Lawrie,GM;Magro,S;Lin,HT;Pacifico,A;Roberts,R;Wyndham,CR
尽管已有儿童房性局灶性心动过速成功手术治疗的报道，但成人这种心律失常的手术治疗仅有孤立的报道。在这个由 8 名患有耐药性右心房局灶性心动过速的患者（年龄 10 至 53 岁）组成的病例系列中，描述了电生理学研究、手术技术和长期随访的结果。在电生理学研究中再现了房性心动过速，心内膜标测定位了所有患者右心房最早开始的心房激动。心外膜标测证实了术中诱发心动过速的 8 名患者中的 7 名患者的房性心动过速灶的位置。在四名仅接受心外膜冷冻消融术治疗的患者中，两名患者出现复发性心动过速，需要进行第二次手术。全部4例右心房切除后均未出现心律失常复发（其中2例单独心外膜冷冻消融后房性局灶性心动过速术中复发），在11至67次（平均30次）的临床随访期间未再出现心律失常复发。结论是，在成年患者中：1）心内膜和心外膜标测的电生理学研究使得房性局灶性心动过速的手术治疗成功； 2）单纯心外膜冷冻消融术可能与术中或术后房性局灶性心动过速复发有关； 3) 右心房次全切除似乎是一种耐受性良好的手术，不会出现房性局灶性心动过速的长期复发。
Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focai tachycardia was reproduced during etectrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients.Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence, in all four patients aftar right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia alter epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 mouths (mean 30).It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.