Elimination of cavotricuspid isthmus conduction by a single ablation lesion: observations from a maximum voltage-guided ablation technique?
Elimination of cavotricuspid isthmus conduction by a single ablation lesion: observations from a maximum voltage-guided ablation technique?
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DOI：
10.1093/europace/eum014
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发表时间：
2007-04-01
期刊：
影响因子：
6.1
通讯作者：
Skanes, Allan C.
中科院分区：
文献类型：
--
作者：
Posan, Emoke;Redfearn, Damian P.;Skanes, Allan C.
目的研究表明，腔三尖瓣峡部的结构是高度可变的，大部分由大量的分散束组成。靶向高振幅信号导致短消融时间，可能是由于这种束的选择性消融。我们报告了一系列单部位消融导致双向阻滞的病例，支持了传导可以发生在峡部离散部分的假设。方法和结果2005年9月至2006年6月间，60例患者采用电压引导入路消融峡部依赖性心房扑动。我们发现，在5例（8.3%）患者（4例，平均年龄58.1±11.4岁）中，通过单部位消融实现了双向阻滞。在6点钟的LAO位置测绘峡部，并在拉回时测量双极振幅以寻找心房电压最大的位置。成功部位的心房和心室电图（EGM）分别为2.00 +/- 1.6 mV和0.2 +/- 0.1 mV，平均心房/心室比为9.1 +/- 4.1。总数是多少。射频时间为83.8 +/- 25.3 s，手术时间为68.6 +/- 10.4 min，包括手术后30 min的等待时间。在5.7 +/- 4.0个月的随访中，颤振未复发。结论以峡部最大心房为靶点，单部位消融可产生双向阻滞。这支持了峡部传导可以发生在峡部离散部分的假设，可能是由于潜在的束结构。
Aims The architecture of the cavotricuspid isthmus has been shown to be highly variable made of a large number of interspersed bundles in the majority. Targeting high-amplitude signals has resulted in short-ablation times, likely due to the selective ablation of such bundles. We report a series of cases where a single site ablation resulted in bidirectional block, supporting the hypothesis that conduction can occur over a discrete portion of the isthmus.Methods and results Sixty consecutive patients underwent ablation for isthmus-dependent atrial flutter using voltage-guided approach between September 2005 and June 2006. We found in five patients (8.3%) (four mate, mean age 58.1 +/- 11.4 years), in whom bidirectional block was achieved by ablation at a single site. The isthmus was mapped at the 6 o'clock LAO position, and bipolar amplitude was measured during pull-back to find the site of largest atrial voltage. The atria[ and ventricular etectrogram (EGM) measured 2.00 +/- 1.6 and 0.2 +/- 0.1 mV, respectively, at the successful site, resulting in the mean atrium /ventricle ratio of 9.1 +/- 4.1. The total. radiofrequency time was 83.8 +/- 25.3 s, and the procedure time was 68.6 +/- 10.4 min, including 30 min waiting time after the procedure. Flutter has not recurred over 5.7 +/- 4.0 months follow-up.Conclusion Targeting the largest atria( EGM in the isthmus can produce bidirectional block with a single site ablation. This supports the hypothesis that trans-isthmus conduction can occur over a discrete part of the isthmus, Likely due to the underlying bundle architecture.