9例矫正型大动脉转位合并室上性心动过速射频消融回顾性分析
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摘要
目的回顾性分析矫正型大动脉转位(ccTGA)合并室上性心动过速(SVT)射频消融特点及结果。方法连续入选9例ccTGA合并SVT患者,完善术前检查后行心内电生理检查及射频消融术,术后定期随访、收集资料。结果 9例患者中,4例房室结折返性心动过速、3例房室折返性心动过速、2例房性心动过速,均于靠近间隔侧消融成功。三维使用率达55.5%(5/9),其中2例心脏解剖变异较大(1例中位心、1例右旋心),应用三维电解剖模型融合CT建模辅助消融均获得成功。术后1例HV间期从40 ms延长至100 ms,其余无明显改变。随访3～75个月1例复发。结论此类患者的术中定位应更加关注左右房间隔侧的标测;ccTGA合并SVT的患者可首选三维电解剖模型融合CT建模辅助射频消融治疗。
Objective To retrospective analysis of radiofrequency catheter ablation(RFCA)of supraventricular tachycardia(SVT)in 9 patients with congenitally corrected transposition of the great arteries(ccTGA). Methods Nine patients with ccTGA referred for RFCA of SVT were studied. Results All 9 patients,contained 4 atrioventricular nodal reentrant tachycardias,3 atrioventricular reentrant tachycardias and 2 atrial tachycardias,were ablated successfully in septum of atrium. 55.5%(5/9)patients were used 3-D mapping. Two of 9 ablated successfully who suffered great anatomic variation of heart were used electroanatomical map merged with 3 D anatomical structure reconstructed from CT slices. After RFCA, patients had no change with the HV interval except one extended from 40 ms to 100 ms. One patient relapsed after Follow-up 3 to 75 months. Conclusions This type of patients should more concern about the mapping in septum of atrium;During RFCA,electroanatomical map merged with 3 D anatomical structure reconstructed from CT slices could be the first choice for SVT patients with ccTGA.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):107-111]
Objective To retrospective analysis of radiofrequency catheter ablation(RFCA)of supraventricular tachycardia(SVT)in 9 patients with congenitally corrected transposition of the great arteries(ccTGA). Methods Nine patients with ccTGA referred for RFCA of SVT were studied. Results All 9 patients,contained 4 atrioventricular nodal reentrant tachycardias,3 atrioventricular reentrant tachycardias and 2 atrial tachycardias,were ablated successfully in septum of atrium. 55.5%(5/9)patients were used 3-D mapping. Two of 9 ablated successfully who suffered great anatomic variation of heart were used electroanatomical map merged with 3 D anatomical structure reconstructed from CT slices. After RFCA, patients had no change with the HV interval except one extended from 40 ms to 100 ms. One patient relapsed after Follow-up 3 to 75 months. Conclusions This type of patients should more concern about the mapping in septum of atrium;During RFCA,electroanatomical map merged with 3 D anatomical structure reconstructed from CT slices could be the first choice for SVT patients with ccTGA.[Chinese Journal of Cardiac Pacing and Electrophysiology,2019,33(2):107-111]
引文
1 Kutty S,Danford DA,Diller GP,et al.Contemporary management and outcomes in congenitally corrected transposition of the great arteries[J].Heart,2018,104(14):1 148
2 Hornung TS,Calder L.Congenitally corrected transposition of the great arteries[J].Heart,2010,96(14):1 154
3 Marelli AJ,Mackie AS,Ionescu-lttu R,et al.Congenital heart disease in the general population:changing prevalence and age distribution [J].Circulation,2007,115(2):163
4 van der Linde D,Konings EE,Slager MA,et al.Birth prevalence of congenital heart disease worldwide:a systematic review and meta-analysis[J].J Am Coll Cardiol,2011,58(21):2 241
5 Tada H,Nogami A,Naito S,et al.Selected slow pathway ablation in a patient with corrected transposition of the great arteries and atrioventricular nodal reentrant tachycardia[J].J Cardiovasc Electrophysiol,1998,9(4):436
6 Eisenberger M,Fox DJ,Earley MJ,et al.Atrioventricular node reentrant tachycardia ablation in a patient with congenitally corrected transposition of the great vessels using the CARTO mapping system[J].J Interv Card Electrophysiol,2007,19(2):129
7 Liao Z,Chang Y,Ma J,et al.Atrioventricular node reentrant tachycardia in patients with congenitally corrected transposition of the great arteries and results of radiofrequency catheter ablation[J].Circ Arrhythm Electrophysiol,2012,5(6):1 143
8 Upadhyay S,Marie Valente A,Triedman JK,et al.Catheter ablation for atrioventricular nodal reentrant tachycardia in patients with congenital heart disease[J].Heart Rhythm,2016,13(6):1 228
9 Guo XG,Liao Z,Ma J,et al.Mapping and ablation of anteroseptal atrial tachycardia in patients with congenitally corrected transposition of the great arteries:implication of pulmonary sinus cusps[J].Europace,2017,19(12):2 015
10 常瑜,任晓庆,张彬,等.右位心、矫正型大动脉转位伴室上性心动过速射频消融成功一例[J].中华心律失常学杂志,2010,(3):239
11 郭晓刚,马坚,刘旭,等.矫正型大动脉转位合并室上性心动过速的电生理特点及射频消融治疗[J].中华心律失常学杂志,2014,18(6):416
12 Baruteau AE,Abrams DJ,Ho SY,et al.Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance[J].J Am Heart Assoc,2017,6(12):e007759.DOI:10.1161/JAHA.117.007759
13 Josephson ME.Clinical cardiac electrophysiology:techniques and interpretations[M].4th ed,Philadelphia.Wolters Kluwer.2008.175-284
14 Nakagawa H,Jackman WM.Catheter ablation of paroxysmal supraventricular tachycardia[J].Circulation,2007,116(21):2 465
15 Xue Y,Zhan X,Wu S,et al.Experimental,pathologic,and clinical findings of radiofrequency catheter ablation of para-hisian region from the right ventricle in dogs and humans[J].Circ Arrhythm Electrophysiol,2017,10(6):e005207.DOI:10.1161/circep.116.005207
16 Van Hare GF,Lesh MD,Stanger P.Radiofrequency catheter ablation of supraventricular arrhythmias in patients with congenital heart disease:results and technical considerations[J].J Am Coll Cardiol,1993,22(3):883
17 Brugada J,Valls V,Freixa R,et al.Radiofrequency ablation of a posteroseptal atrioventricular accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with congenitally corrected transposition of the great arteries[J].Pacing Clin Electrophysiol,2000,23(1):133
18 Ouyang F,Ma J,Ho SY,et al.Focal atrial tachycardia originating from the non-coronary aortic sinus:electrophysiological characteristics and catheter ablation[J].J Am Coll Cardiol,2006,48(1):122
2 Hornung TS,Calder L.Congenitally corrected transposition of the great arteries[J].Heart,2010,96(14):1 154
3 Marelli AJ,Mackie AS,Ionescu-lttu R,et al.Congenital heart disease in the general population:changing prevalence and age distribution [J].Circulation,2007,115(2):163
4 van der Linde D,Konings EE,Slager MA,et al.Birth prevalence of congenital heart disease worldwide:a systematic review and meta-analysis[J].J Am Coll Cardiol,2011,58(21):2 241
5 Tada H,Nogami A,Naito S,et al.Selected slow pathway ablation in a patient with corrected transposition of the great arteries and atrioventricular nodal reentrant tachycardia[J].J Cardiovasc Electrophysiol,1998,9(4):436
6 Eisenberger M,Fox DJ,Earley MJ,et al.Atrioventricular node reentrant tachycardia ablation in a patient with congenitally corrected transposition of the great vessels using the CARTO mapping system[J].J Interv Card Electrophysiol,2007,19(2):129
7 Liao Z,Chang Y,Ma J,et al.Atrioventricular node reentrant tachycardia in patients with congenitally corrected transposition of the great arteries and results of radiofrequency catheter ablation[J].Circ Arrhythm Electrophysiol,2012,5(6):1 143
8 Upadhyay S,Marie Valente A,Triedman JK,et al.Catheter ablation for atrioventricular nodal reentrant tachycardia in patients with congenital heart disease[J].Heart Rhythm,2016,13(6):1 228
9 Guo XG,Liao Z,Ma J,et al.Mapping and ablation of anteroseptal atrial tachycardia in patients with congenitally corrected transposition of the great arteries:implication of pulmonary sinus cusps[J].Europace,2017,19(12):2 015
10 常瑜,任晓庆,张彬,等.右位心、矫正型大动脉转位伴室上性心动过速射频消融成功一例[J].中华心律失常学杂志,2010,(3):239
11 郭晓刚,马坚,刘旭,等.矫正型大动脉转位合并室上性心动过速的电生理特点及射频消融治疗[J].中华心律失常学杂志,2014,18(6):416
12 Baruteau AE,Abrams DJ,Ho SY,et al.Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance[J].J Am Heart Assoc,2017,6(12):e007759.DOI:10.1161/JAHA.117.007759
13 Josephson ME.Clinical cardiac electrophysiology:techniques and interpretations[M].4th ed,Philadelphia.Wolters Kluwer.2008.175-284
14 Nakagawa H,Jackman WM.Catheter ablation of paroxysmal supraventricular tachycardia[J].Circulation,2007,116(21):2 465
15 Xue Y,Zhan X,Wu S,et al.Experimental,pathologic,and clinical findings of radiofrequency catheter ablation of para-hisian region from the right ventricle in dogs and humans[J].Circ Arrhythm Electrophysiol,2017,10(6):e005207.DOI:10.1161/circep.116.005207
16 Van Hare GF,Lesh MD,Stanger P.Radiofrequency catheter ablation of supraventricular arrhythmias in patients with congenital heart disease:results and technical considerations[J].J Am Coll Cardiol,1993,22(3):883
17 Brugada J,Valls V,Freixa R,et al.Radiofrequency ablation of a posteroseptal atrioventricular accessory pathway in a left-sided tricuspid ring with Ebsteinlike anomaly in a patient with congenitally corrected transposition of the great arteries[J].Pacing Clin Electrophysiol,2000,23(1):133
18 Ouyang F,Ma J,Ho SY,et al.Focal atrial tachycardia originating from the non-coronary aortic sinus:electrophysiological characteristics and catheter ablation[J].J Am Coll Cardiol,2006,48(1):122
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