马歇尔束相关性房性心动过速的临床和电生理特征：基于明确诊断的考虑。

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-02-01 DOI:10.1016/j.jacep.2024.10.019

Yasuaki Tanaka MD , Atsushi Takahashi MD , Hirotaka Yano MD , Naohiko Kawaguchi MD , Emiko Nakashima MD , Kenji Okubo MD , Hiroyuki Hikita MD , Tetsuo Sasano MD

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引用次数: 0

摘要

背景：传统的心内膜测图不能完全阐明马歇尔束（MB）相关的心房心动过速（AT）。目的：本研究旨在通过导管插入明确诊断mb相关AT的临床和电生理特征。方法：48例既往行二尖瓣峡部消融术的AT患者纳入本研究。如果心内膜左心房测图显示离心传播，且夹带起搏后起搏间隔提示宏观再入机制，则将1.6 f六极电极导管插入Marshall静脉（VOM）。只有当沿VOM的激活与AT电路的传播一致，并且VOM内的起搏后间隔近似于心动过速周期长度时，才能诊断mb相关的AT。结果：48例患者中，20例诊断为mb相关AT。沿VOM的激活方向以下行为主（n = 13），而非上行（n = 7）。沿VOM的过程，心内膜有不同的突破位点。两名患者经历了持续的AT，尽管在VOM传导阻滞。13例采用乙醇注射化学消融术，其余7例在最早的心内膜激活部位或二尖瓣峡区进行射频消融术。20例患者出现急性AT终止。化学消融组无复发；然而，射频组有4例患者复发（n = 0 / 13 vs n = 4 / 7）。结论：了解mb相关AT的独特临床和电生理特征有助于诊断和治疗该AT类型。

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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Clinical and Electrophysiological Characteristics of Marshall Bundle–Related Atrial Tachycardia

Background

Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)–related atrial tachycardia (AT).

Objectives

This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.

Methods

Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study. A 1.6-F hexapolar electrode catheter was inserted into the vein of Marshall (VOM) if endocardial left atrial mapping showed centrifugal propagation and post-pacing intervals after entrainment pacing suggested a macro-re-entrant mechanism. MB-related AT was diagnosed only when activation along the VOM was consistent with the propagation of the AT circuit, and post pacing interval within the VOM approximated the tachycardia cycle length.

Results

Among 48 patients, 20 were diagnosed with MB-related AT. The activation direction along the VOM was predominantly descending (n = 13), rather than ascending (n = 7). There were diverse breakthrough sites to the endocardium along the course of the VOM. Two patients experienced persistent AT despite a conduction block in the VOM. Thirteen patients underwent chemical ablation with ethanol injection, and the remaining 7 underwent radiofrequency ablation at the earliest endocardial activation sites or mitral isthmus areas. Acute termination of AT was observed in 20 patients. No recurrence was observed in the group that underwent chemical ablation; however, 4 patients in the radiofrequency group experienced recurrence (n = 0 of 13 vs n = 4 of 7).

Conclusions

Understanding the distinct clinical and electrophysiological characteristics of MB-related AT can facilitate the diagnosis and treatment of this AT type.

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.