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目的 心外科术后大折返性房性心动过速(MATs)的保护性峡部多数位于舒张期.设置新的兴趣窗(WOI)识别大折返环的舒张传导区(DCZ)指导MATs的消融.方法 所有患者均在En Stei三维标测系统下进行高密度激动标测.MATs发作时根据P波顶点的位置计算WOI.WOI的起点位于折返环的舒张期,并通过激动图上白/紫相接部位识别DCZ.结果 连续纳入心外科术后15例MATs的患者.一共完成了16种MATs[周长(259±56)ms]的标测.通过新的WOI设置识别16种MATs的DCZ[宽度(25.38±12.44)mm]均位于受保护的峡部.DCZ局部的传导速度明显慢于收缩期区域的传导速度[(38.9±13.68)cm/svs(76.24±15.85)cm/s,P<0.05].DCZ部位即刻消融成功率为100%.随访(11.5±5)个月,共有2例患者房性心律失常复发.结论 通过新的WOI设置可以在电解剖标测图上根据白/紫相接的部位识别心外科术后MATs患者传导缓慢的DCZ部位.DCZ部位多数位于受保护的峡部,多数显示有碎裂电位.消融DCZ可以有效的终止心动过速.
Most of the protective isthmus with large reentrant atrial tachycardia (MATs) in diastole was located at diastole.A new window of interest (WOI) was set up to identify the diastolic conduction zone (DCZ) of the maxillary reentrant ring to guide the ablation of MATs. All patients underwent high-density excitement mapping under the En Stei three-dimensional mapping system.MATs were calculated based on the location of the peak of the P wave WOI.WOI was located in the reentrant ring of the diastolic phase, and by agitation white / purple phase connection DCZ was identified in all the patients.Results A total of 16 MATs [perimeter (259 ± 56) ms] were completed in 15 consecutive cases of patients with MATs after cardiothoracic surgery.The DCI [width (25.38 ± 12.44) mm] were located in the protected isthmus, and the local conduction velocity in DCZ was significantly slower than that in the systolic region (38.9 ± 13.68 cm / s vs 76.24 ± 15.85 cm / s, P <0.05] .At the same time, the success rate of ablation of DCZ site was 100% .At a follow-up of (11.5 ± 5) months, a total of 2 patients had atrial arrhythmia recurrence.Conclusion The new WOI setting can be used in the electro- Of the parts of the DCS to identify the delayed transmission of DCZ parts of MATS patients after cardiac surgery.The majority of DCZ sites located in the protected isthmus, Most show fragmentation potential. Ablation of DCZ can effectively terminate the tachycardia.