Treatment of atrial tachycardia arising after superior transseptal approach mitral valve surgery: Insights from ultra-high-density mapping to prevent atrioventricular block.

Pacing and clinical electrophysiology : PACE Pub Date : 2022-09-01 Epub Date: 2022-08-09 DOI:10.1111/pace.14569
Satoshi Hara, Shigeki Kusa, Naoyuki Miwa, Hidenori Hirano, Tadanori Nakata, Junichi Doi, Yun Teng, Yoshikazu Satoh, Kazuya Yamao, Hitoshi Hachiya
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引用次数: 2

Abstract

Introduction: Mitral valve surgery employing a superior transseptal approach (STA) is associated with arrhythmogenicity and intra-atrial conduction delay, despite being optimal for visualization of the surgical field. It is sometimes difficult to treat atrial tachycardias (AT) that arise after STA. To investigate AT circuits that arise after STA in detail in order to identify the optimal ablation line, using ultra-high-resolution mapping (UHRM).

Methods: We retrospectively analyzed 12 AT from 10 patients (median age 70 years, nine males) who had undergone STA surgery. The tachycardias were mapped using the Rhythmia mapping system (Boston Scientific, Natick, Massachusetts).

Results: The 12 STA-related AT (STA-AT) circuits were classifiable as follows according to location of the optimal ablation line: (1) peri-septal incision STA-AT (n = 3), (2) cavotricuspid isthmus (CTI) dependent STA-AT (n = 7), and (3) biatrial tachycardia (n = 2). Radiofrequency (RF) application terminated 11 of the 12 STA-AT. We found that difference in STA-AT circuit type was due to characteristics of the septal incision line made for STA. UHRM was important in identifying optimal ablation sites that did not create additional conduction disturbances in the right atrium (RA).

Conclusions: ATs after STA involve complex arrhythmia circuits due to multiple and long incision lines in the RA. Accurate understanding of the arrhythmia circuit and sinus conduction in the RA after STA is recommended for treating post-surgical tachycardia in a minimally invasive manner.

上隔二尖瓣手术后房性心动过速的治疗:超高密度测绘预防房室传导阻滞的见解。
简介:二尖瓣手术采用上间隔入路(STA)与心律失常和房内传导延迟有关,尽管它是最佳的手术视野。房颤后出现的房性心动过速(AT)有时很难治疗。使用超高分辨率映射(UHRM)详细研究STA后出现的AT电路,以确定最佳烧蚀线。方法:我们回顾性分析10例接受STA手术的患者(中位年龄70岁,9例男性)的12例AT。使用心律失常制图系统(Boston Scientific, Natick, Massachusetts)对心动过速进行制图。结果:根据最佳消融线的位置,12个sta相关的AT (STA-AT)回路可分为:(1)间隔周围切口STA-AT (n = 3),(2)依赖于cavotricuspid峡(CTI)的STA-AT (n = 7)和(3)双房性心动过速(n = 2)。射频(RF)应用终止了12个STA-AT中的11个。我们发现STA- at电路类型的差异是由于STA的鼻中隔切口线的特点。UHRM在确定不产生额外右心房传导干扰的最佳消融位点(RA)方面很重要。结论:STA后的ATs由于RA切口多且长,涉及复杂的心律失常回路。准确了解STA后RA的心律失常回路和窦性传导,建议以微创方式治疗术后心动过速。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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