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目的总结先天性心脏病(简称先心病)患者外科术后房性心动过速(简称房速)的电生理机制、导管射频消融方法及结果。方法入选先心病外科术后房速患者,首先行电生理检查明确房速起源心腔。之后在三维标测系统(CARTO或EnSite-NavX)指导下行靶心腔的电解剖标测,明确房速机制后对大折返关键峡部或局灶房速的最早激动点进行消融。结果共入选26例,诱发出30种心动过速,其中单纯为三尖瓣峡部依赖性心房扑动(简称房扑)13例;单纯右房疤痕折返房速4例;右房疤痕房速合并房扑6例,其中3例为两者同时存在形成“8”字折返,3例为两者先后出现;单纯局灶性房速2例;合并有疤痕折返及局灶两种机制的1例。首次消融手术成功率96.2%(25/26),随访(38±23)个月,有6例患者复发。共经三次消融后,总体手术成功率88.4%(23/26)。结论先心病外科术后的房速以三尖瓣环大折返房扑最为常见,其次为游离壁大折返;总体而言,射频消融成功率较高。
Objective To summarize the electrophysiological mechanism of atrial tachycardia (referred to as atrial tachycardia) in patients with congenital heart disease (referred to as CHD) and the radiofrequency catheter ablation method and results. Methods Selected patients with congenital heart disease after surgery, the first line of electrophysiology to identify atrial tachycardia heart rate. Afterwards, the electroanatomical mapping of the target chamber was performed under the guidance of CARTO or EnSite-NavX, and the earliest agitation point of the key isthmus or focal atrial maxillae was ablated after the mechanism of atrial tachycardia was clarified. Results Totally 26 cases were selected and 30 kinds of tachycardia were induced, including 13 cases of atrial flutter (atrial flutter) only based on tricuspiral isthmus; 4 cases of atrial fibrillation with right atrial scar Atrial flutter in 6 cases, of which 3 cases of the two exist at the same time the formation of “8 ” word reentry, three cases appeared in two cases; simple focal atrial tachycardia in 2 cases; with scar reentry and focal two mechanisms 1 case. The success rate of the first ablation was 96.2% (25/26), followed up (38 ± 23) months and 6 patients relapsed. After a total of three ablations, the overall surgical success rate was 88.4% (23/26). Conclusions The rate of atrial tachycardia after tricuspid valve annulus fibrillation is the most common in the patients with congenital heart disease, followed by the return of the free wall. In general, the success rate of radiofrequency ablation is high.