【摘要】 【目的】观察在高密度、高分辨率视觉下的心外科术后房性心动过速(房速)的电生理特点及消融效果。【方法】回顾分析自2016年3月至2019年12月在中山大学附属第一医院因心外科术后房速,应用Orion微电极网蓝与Rhythmia标测系统进行标测消融治疗的全部患者。【结果】共入选21名患者,总共记录到26种房速,平均每种房速的标测时间为(19.1±7.1)min,所采取的电图(19 495±12 798)个。26种房速中,按部位分:20(76.9%)个位于右房,5(19.2%)个位于左房,1(3.8%)个为左右双房大折返;按心动过速机制分:24(92.3%)个为大折返房速,1(3.8%)个为微折返,1(3.8%)个为局灶房速。在大折返房速中,7个为双环"8"字折返,消融一环过程中有4个转为单环折返。另有一例为跨房间隔传导的双房大折返。21例患者2例复发,其中1例当时仅对游离壁疤痕至下腔静脉的连线进行消融,后再次手术时标测为三尖瓣峡部依赖性房速。【结论】心外科术后房速形式多样,以大折返房速为主,极少数为微折返或局灶起源。大折返房速可表现为双环折返或双房大折返。消融时除针对本次心动过速外,还需根据心房的基质情况进行预防性干预。更多还原

【Abstract】 【Objective】To explore the electrophysiologic characteristics of post-cardiac-surgical atrial tachycardia(AT)under ultra-high density and high-resolution mapping.【Methods】Consecutive cases with post-cardiac-surgical AT and taking mapping using Orion basketball mini-electrode and Rhythmia mapping system were collected and analyzed in the first affiliated hospital of Sun Yat-sen University from march 2016 to december 2019.【Results】Totally 26 ATs were recorded in the 21 patients with a mean mapping time(19.1±7.1)min. Among them,20(76.9%)ATs located in right atrium,5(19.2%)in left atrium,and one was a bi-atrial macro-reentrant AT. According the difference of tachycardia mechanism,24(92.3%)were macro-reentrant ATs,one was micro-reentrant,and the other was local activation. In the macro-reentrant ATs,7 cases showed a dual-loop reentrant circuit configurated"figure-of-eight",one was a bi-atrial macro-reentry with a transmural conduction from left side to right side of atrial septum. During ablation,4 patients in the 7 cases with"figure-of-eight"dual-loop reentries turned into a single-loop reentry. During follow-up with an average of 16(4,36)months,2 cases recurred,and one was because of no prophylactic ablation on the tricuspid isthmus.【Conclusions】Post-cardiac-surgical atrial tachycardia mainly manifests as complicated macro-reentrant AT. Some show a dual-loop reentry and sometimes a bi-atrial macro-reentry. During ablation,some prophylactic ablation according to the substrate is necessary.更多还原