Cryoablation for atrial tachycardia with cycle length variability originating from the vicinity of the sinus node
Cryoablation for atrial tachycardia with cycle length variability originating from the vicinity of the sinus node
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冷冻消融治疗源于窦房结附近周期长度变异的房性心动过速
DOI：
10.1016/j.jccase.2022.10.009
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发表时间：
2023
影响因子：
--
通讯作者：
Tanaka Atsushi
中科院分区：
文献类型：
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作者：
Kashiwagi Manabu;Kuroi Akio;Miyake Daichi;Shimomine Eiko;Teruya Yusuke;Otsuki Yuto;Higashimoto Natsuki;Terada Kosei;Nakamura Kazutaka;Tanaka Atsushi
该病例涉及房性心动过速，其周期长度可变性源自窦房结附近，并且未实现评估心动过速回路的诊断性起搏操作。激活标测显示房性心动过速的起源距离窦房结15mm，在房性心动过速后部起搏捕获膈神经。将多极导管置于右头臂静脉中，通过起搏捕获右膈神经。通过触诊持续的膈肌运动来证实不存在膈神经麻痹。通过确认膈肌的持续运动，冷冻消融可以安全有效地进行，不会造成窦房结损伤和膈神经麻痹。冷冻消融在传导系统和膈神经附近的疗效将在未来得到越来越多的证实。学习目的当诊断性起搏操作由于心动过速周期长度的变化而无法估计回路时，与传统射频消融相比，冷冻消融治疗房性心动过速可能在消融引起的传导系统损伤和膈神经麻痹方面更安全、更有效。
This case is about atrial tachycardia with cycle length variability originating from the vicinity of the sinus node and diagnostic pacing maneuvers to assess the tachycardia circuit were not achieved. Activation mapping revealed that the origin of atrial tachycardia was 15 mm away from the sinus node and the phrenic nerve was captured by pacing at the posterior portion of atrial tachycardia. A multipolar catheter was placed in the right brachiocephalic vein to capture the right phrenic nerve by pacing. The absence of phrenic nerve palsy was confirmed by palpation of constant diaphragmatic movement. The cryoablation could be safely and efficiently performed without ablation-induced injury of sinus node and phrenic nerve palsy by confirming constant diaphragmatic movement. The efficacy of cryoablation in the vicinity of the conduction system and phrenic nerve will be increasingly confirmed in the future.Learning ObjectiveCryoablation for atrial tachycardia might be more safe and effective in terms of ablation-induced injury of conduction system and phrenic nerve palsy compared with conventional radiofrequency ablation when diagnostic pacing maneuvers are not able to estimate the circuit due to variability of tachycardia cycle length.