【摘要】 目的:探讨存在自发疤痕的心房扑动(房扑)患者的电生理特征及消融效果。方法:对我科2014-2016年行电生理检查及射频消融的房扑患者进行筛查,所有房扑消融患者消融前均行冠状动脉(冠脉)造影或冠脉CTA检查,进一步行心脏电生理检查,并在三维电解剖指导下行射频消融。消融前行电激动标测及电压标测。共12例房扑患者标测到自发疤痕,其中7例右房房扑于右房标测到自发疤痕,5例左房房扑于左房标测到自发疤痕。结果:右房房扑组疤痕占总心房比例显著高于左房房扑组[(11.1±11.7)%∶(7.8±2.8)%,P<0.05]。右房房扑组消融急性成功率为85.7%,左房房扑组为100%,两组差异无统计学意义。随访中,3例右房房扑患者房扑复发,第2次电压标测提示疤痕较前增加;1例左房房扑患者复发,未见疤痕增加;3例右房房扑患者出现窦房结功能障碍,需行永久起搏器植入,左房房扑患者无起搏器植入者。结论:自发疤痕可能成为心房扑动的机制,但也可能为旁观者。与左房房扑比较,存在自发疤痕的右房房扑可能进展至窦房结导致病窦综合征,需安置起搏器。更多还原

【Abstract】 Objective:To characterize the electrophysiologic and mapping features of spontaneous scar based atrial flutter(AFL)and outcomes of catheter ablation.Method:Consecutive patients with a diagnosis of AFL who underwent catheter ablation from Jan 2012 to Jun 2015 were screened.Scars were detected in 12 patients and were included in this study.All had negative coronary angiography.These patients were divided into right AFL group(n=7)and left AFL group(n=5)based on electrophysiologic mappings.Result:The proportion of scar area in right AFL group was significant higher than that in left AFL group[(11.1±11.7)% vs(7.8±2.8)%,P<0.05].The acute success rates of ablation was 85.7%in right AFL group and 100%in left AFL group,there was no significant difference in two groups.During the follow-up,extansion of scar area was noted in 3 patients with recurrent of right AFL,no scar expension was noted in 1 patient with recurrent of left AFL,3 patients with right AFL required permanent pacemaker implantation for sinus node dysfunction,and no one required pacemaker in patients with left AFL. Conclusion:Spontaneous scar could serve as substrate for AFL in right or left atrium.Compared with left AFL,there is a higher rate of recurrence and pacemaker implantation in patients with right AFL.更多还原