PDF(Pubmed)
Abstract：
UNASSIGNED: Double-wave macrore-entry is a rare mechanism of atrial tachycardia with limited documentation in the literature. We present a three-dimensional documentation of a double-wave \'typical\' atrial flutter in a patient with extensive atrial cardiomyopathy.
UNASSIGNED: A 78-year-old female with a history of atrial cardiomyopathy and dual-chamber pacemaker for sinus node disease presented with palpitations and incessant atrial flutter. Electrophysiological study revealed a regular tachycardia with a cycle length (TCL) of 230 ms, with proximal to distal coronary sinus (CS) activation. Three-dimensional mapping identified two independent wavefronts circulating the cavotricuspid isthmus (CTI), each with a TCL of 460 ms. Cavotricuspid isthmus ablation resulted in conversion into a distinct tachycardia with left atrial roof origin. Linear ablation in this location slowed the TCL to 435 ms with concentric CS activation and another CTI dependent atrial flutter was mapped, this time with only one wavefront of activation. Further ablation with a second, more lateral, line in the CTI led to tachycardia interruption. Given the extensive atrial scarring and high arrhythmic recurrence risk, atrioventricular node ablation was performed.
UNASSIGNED: Double-wave re-entrant tachycardias were primarily observed in experimental models, precipitating acceleration of ventricular and supraventricular tachycardias via extrastimulation. In our case, there is documentation of a spontaneous double-wave of activation around the CTI, representing the first documented double-wave \'typical\' atrial flutter. Unlike other cases in the literature, the two wavefronts were equidistant, which resulted in a regular tachycardia with TCL that was half of the single-wave cycle length. Three-dimensional propagation mapping was essential to visualize the two distinct wavefronts.
UNASSIGNED: A 78-year-old female with a history of atrial cardiomyopathy and dual-chamber pacemaker for sinus node disease presented with palpitations and incessant atrial flutter. Electrophysiological study revealed a regular tachycardia with a cycle length (TCL) of 230 ms, with proximal to distal coronary sinus (CS) activation. Three-dimensional mapping identified two independent wavefronts circulating the cavotricuspid isthmus (CTI), each with a TCL of 460 ms. Cavotricuspid isthmus ablation resulted in conversion into a distinct tachycardia with left atrial roof origin. Linear ablation in this location slowed the TCL to 435 ms with concentric CS activation and another CTI dependent atrial flutter was mapped, this time with only one wavefront of activation. Further ablation with a second, more lateral, line in the CTI led to tachycardia interruption. Given the extensive atrial scarring and high arrhythmic recurrence risk, atrioventricular node ablation was performed.
UNASSIGNED: Double-wave re-entrant tachycardias were primarily observed in experimental models, precipitating acceleration of ventricular and supraventricular tachycardias via extrastimulation. In our case, there is documentation of a spontaneous double-wave of activation around the CTI, representing the first documented double-wave \'typical\' atrial flutter. Unlike other cases in the literature, the two wavefronts were equidistant, which resulted in a regular tachycardia with TCL that was half of the single-wave cycle length. Three-dimensional propagation mapping was essential to visualize the two distinct wavefronts.
摘要：
■双波进入是一种罕见的房性心动过速机制，文献文献有限。我们提供了患有广泛心房心肌病的患者的双波典型房扑的三维文档。
■一名78岁女性，有房性心肌病和窦房结疾病的双腔起搏器病史，表现为心悸和不停的房扑。电生理研究显示有规律的心动过速，周期长度（TCL）为230毫秒，与近端到远端冠状窦（CS）激活。三维标测确定了循环三尖瓣峡部（CTI）的两个独立波前，每个具有460ms的TCL。三尖瓣峡部消融导致转换为具有左心房顶部起源的明显心动过速。此位置的线性消融使TCL在同心CS激活的情况下减慢至435ms，并标测了另一个CTI依赖性房扑，这一次只有一个波前激活。用一秒进一步消融，更横向，CTI中的线路导致心动过速中断。鉴于广泛的心房瘢痕形成和高心律失常复发风险，进行房室结消融.
■主要在实验模型中观察到双波折返性心动过速，通过超刺激加速心室和室上性心动过速。在我们的案例中,有文件记录显示CTI周围有自发的双波激活，代表第一个记录的双波典型房扑。与文献中的其他案例不同，两个波前是等距的，导致TCL有规律的心动过速，是单波周期长度的一半。三维传播映射对于可视化两个不同的波前至关重要。
■一名78岁女性，有房性心肌病和窦房结疾病的双腔起搏器病史，表现为心悸和不停的房扑。电生理研究显示有规律的心动过速，周期长度（TCL）为230毫秒，与近端到远端冠状窦（CS）激活。三维标测确定了循环三尖瓣峡部（CTI）的两个独立波前，每个具有460ms的TCL。三尖瓣峡部消融导致转换为具有左心房顶部起源的明显心动过速。此位置的线性消融使TCL在同心CS激活的情况下减慢至435ms，并标测了另一个CTI依赖性房扑，这一次只有一个波前激活。用一秒进一步消融，更横向，CTI中的线路导致心动过速中断。鉴于广泛的心房瘢痕形成和高心律失常复发风险，进行房室结消融.
■主要在实验模型中观察到双波折返性心动过速，通过超刺激加速心室和室上性心动过速。在我们的案例中,有文件记录显示CTI周围有自发的双波激活，代表第一个记录的双波典型房扑。与文献中的其他案例不同，两个波前是等距的，导致TCL有规律的心动过速，是单波周期长度的一半。三维传播映射对于可视化两个不同的波前至关重要。
