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目的应用电解剖标测系统分析3例大折返房性心动过速(房速)的电生理机制并导航消融。方法3例房速患者(男1例,女2例),平均年龄51±12岁,心动过速病史19±11年。常规电生理检查初步确定房速所在心腔,使用电解剖标测系统构建心房三维模型,完成电压和激动标测,分析心动过速的机制并确定缓慢传导区(即关键峡部),使用冷生理盐水灌注导管消融。结果3例患者临床常规检查初步排除结构性心脏病,电压标测均显示被标测心房存在疤痕区。病例1为围绕三尖瓣环顺钟向的大折返房速,关键峡部位于三尖瓣环与后侧壁的疤痕之间。病例2为围绕上腔静脉逆钟向的大折返房速,关键峡部位于右房侧壁疤痕与上腔静脉之间。病例3为左房8字形折返,关键峡部位于左房顶部的两片疤痕之间。3例患者均在关键峡部消融成功,随访9～10个月未见复发。结论电解剖标测可以揭示大折返房速的基质,阐明折返机制,并有效指导消融。
Objective To analyze the electrophysiological mechanism of 3 cases of atrial tachycardia (atrial tachycardia) and navigate ablation by using electroanatomic mapping system. Methods Three patients with atrial tachycardia (1 males and 2 females) with an average age of 51 ± 12 years and a history of tachycardia of 19 ± 11 years. Routine electrophysiological examination to determine the location of the heart chamber, the use of electroanatomic mapping system to build three-dimensional model of the atrium to complete the voltage and the activation of mapping, analysis of tachycardia mechanism and to determine the slow conduction area (ie, the key isthmus), the use of cold physiology Saline infusion catheter ablation. Results The clinical routine examination of 3 patients initially ruled out structural heart disease. Voltage mapping showed that there was a scar area in the marked atria. Case 1 is a large anterior chamber velocity around the tricuspid annulus, and the key isthmus is located between the scar of the tricuspid annulus and the posterior wall. Case 2 is a large anterior torsion velocity around the superior vena cava, and the key isthmus is located between the scar of the right atrium and the superior vena cava. Case 3 is a left atrium 8-shaped reentry, the key isthmus is located in the top of the left atrium between the two scars. Three patients were successfully ablated in the key isthmus, no follow-up of 9 to 10 months recurrence. Conclusion Electroanatomical mapping can reveal the matrix of the large reentry velocity, clarify the mechanism of reentry and effectively guide the ablation.