Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve.
Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve.
复制标题
从主动脉瓣非冠状尖部导管消融房室结周围房性心动过速。
DOI：
10.1111/j.1540-8167.2007.01024.x
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发表时间：
2008
影响因子：
2.7
通讯作者：
Reddy,VivekY
中科院分区：
文献类型：
--
作者：
Das,Saumya;Neuzil,Petr;Albert,ChristineM;D'Avila,Andre;Mansour,Moussa;Mela,Theofanie;Ellinor,PatrickT;Singh,Jagmeet;Patton,Kristen;Ruskin,JeremyN;Reddy,VivekY
简介：起源于房室结附近主动脉根前间隔区域的房性心动过速 (AT) 很难通过导管消融安全消除。在这项研究中，我们检查了我们中心的一组患者的前间隔 AT 的特征，并证明了从非冠状主动脉瓣尖 (NCC) 基部内针对心律失常的长期疗效和安全性。方法和结果：在 54 名接受侵入性电生理评估的有症状局灶性 AT 患者的队列中，最早右侧的点 10 名患者的心房 (RA) 激活位于房室结周围区域，位于希氏束的后上方。在进一步定位之前，两名患者体内放置的 RA 病变未能成功消除心律失常。由于 NCC 基部靠近房间隔，因此使用逆行主动脉入路绘制 NCC 底部图，并揭示了一个不存在希氏电位的早期激活点。射频或冷热能量输送不到 10 秒即可终止心律失常，并在 10 名患者中有 7 名成功消除。其他三名患者注意到 AT 短暂终止或加速，促使从左心房间隔位置成功消融或从 para-Hisian RA 位置重新尝试。所有患者在随访期间（41±12 个月）均未出现心律失常。结论：NCC 基底部内的导管消融是消除 AV 结区周围局灶性 AT 的安全有效的方法。
Introduction:Atrial tachycardias (AT) originating from the anteroseptal region of the aortic root, near the atrioventricular node can be challenging to eliminate safely by catheter ablation. In this study, we examine the characteristics of anteroseptal ATs in a cohort of patients at our centers, and demonstrate the long‐term efficacy and safety of targeting the arrhythmias from within the base of the noncoronary aortic valve cusp (NCC).Methods & Results:From among a cohort of 54 patients with symptomatic focal AT undergoing invasive electrophysiological evaluation, the point of earliest right atrial (RA) activation was at the peri‐AV nodal region in 10 patients, just postero‐superior to the His‐bundle. Before further mapping, RA lesions placed in two patients were unsuccessful in eliminating the arrhythmia. Because of its proximity to the interatrial septum, the base of the NCC was mapped using a retrograde aortic approach, and revealed a point of early activation without the presence of a His potential. The arrhythmia terminated with <10 seconds of radiofrequency or cryothermal energy delivery and was successfully eliminated in 7 of 10 patients. Transient termination or acceleration of the AT was noted in the other three patients, prompting successful ablation from a left atrial septal position or a reattempt from a para‐Hisian RA position. All patients have been arrhythmia free during follow‐up (41 ± 12 months).Conclusions:Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri‐AV nodal region.