非典型房扑(AFL)常见于术后心房瘢痕患者,疤痕中的宏观或微观通道充当折返的底物。不同的心房疤痕会导致不同的扑动回路,这使得标测和消融具有挑战性,并复发常见。
我们假设动态调整电压阈值可以识别异质性心房瘢痕,然后可以将其有效均质化以消除非典型AFL。
我们研究了连续的患者,这些患者到电生理实验室进行非典型AFL消融术,有心房切开术史,在我们的研究中,在映射过程中变化的颤振电路。我们排除了稳定的颤振回路的患者,该回路是持续的,并且可以使用传统的夹带和激活映射策略进行定位。在纳入的患者中,我们对感兴趣的心房进行了详细的高密度电压图.我们根据需要调整了电压阈值,以识别疤痕区域的异质性和通道。使用灌注式智能触摸消融导管进行彻底的疤痕均匀化。心动过速的再诱导性,并研究了近期和长期结果。
在五个研究案例中,一个是女性;年龄66±10岁。所有五个都具有先前的手术基质。所有患者都有多种扑动形态,随着我们绘制AFL的变化。疤痕均匀化后,任何患者均未诱发心动过速。在450±27天的平均随访期间,没有发现扑动复发。
高密度电压映射和疤痕的均质化可以是消除具有多个回路的复杂疤痕介导的非典型AFL的有效策略。
Atypical atrial flutter (AFL) is common in patients with postsurgical atrial scar, with macro- or microscopic channels in the scar acting as substrate for reentry. Heterogeneous atrial scarring can cause varying flutter circuits, which makes mapping and ablation challenging, and recurrences common.
We hypothesize that dynamically adjusting voltage thresholds can identify heterogeneous atrial scarring, which can then be effectively homogenized to eliminate atypical AFLs.
We studied consecutive patients who presented to Electrophysiology laboratory for atypical AFL ablation with history of atriotomy and included the patients with multiple, varying flutter circuits during mapping in our study. We excluded patients with stable flutter circuit that was sustained and could be localized using traditional entrainment and activation mapping strategy. In the included patients, we performed detailed high-density voltage map of the atrium of interest. We adjusted voltage thresholds as needed to identify heterogeneity and channels in the scarred regions. A thorough scar homogenization was performed with irrigated smart-touch ablation catheter. Re-inducibility of tachycardia, and immediate and long-term outcomes were studied.
Of five studied cases, one was female; age 66 ± 10 years. All five had prior surgical substrate. All the patients had multiple flutter morphologies, which varied as we mapped the AFL. After scar homogenization, tachycardia was not inducible in any patient. No recurrence of flutter was noted during a mean follow-up duration of 450 ± 27 days.
High-density voltage mapping and homogenization of the scar can be an effective strategy in eliminating complex scar-mediated atypical AFL with multiple circuits.