[1]柯嘉伟 黄松群 黄新苗 马丽萍.左心房心房扑动射频消融治疗进展[J].心血管病学进展,2023,(5):425.[doi:10.16806/j.cnki.issn.1004-3934.2023.05.010]
　KE Jiawei,HUANG Songqun,HUANG Xinmiao,et al.Advances in Radiofrequency Catheter Ablation of Left Atrial Flutter[J].Advances in Cardiovascular Diseases,2023,(5):425.[doi:10.16806/j.cnki.issn.1004-3934.2023.05.010]
点击复制

左心房心房扑动射频消融治疗进展()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2023年5期
页码:
425
栏目:
综述
出版日期:
2023-05-25

文章信息/Info

Title:
Advances in Radiofrequency Catheter Ablation of Left Atrial Flutter
作者:
柯嘉伟 黄松群 黄新苗 马丽萍
(海军军医大学(第二军医大学)
Author(s):
KE Jiawei;  HUANG Songqun;  HUANG Xinmiao;  MA Liping
(Department of Cardiovasology,The First Affiliated Hospital of Naval Medical University (Second Military Medical University),Shanghai 200433,China )
关键词:
左心房房扑; 射频消融; 三维电解剖标测
Keywords:
Left atrial flutter;  Radiofrequency ablation;  3D Electroanatomic mapping
DOI:
10.16806/j.cnki.issn.1004-3934.2023.05.010
摘要:
心房扑动（房扑）是一种大折返性心律失常，与心房颤动关系密切，二者经常共存。导管消融术已经成为房扑治疗的一线治疗措施，但随访发现患者消融术后新发房性心律失常比例仍然较高。左心房房扑与典型右心房房扑相比机制更为复杂，常与各种原因导致的左心房纤维化有关，且左心房周围毗邻结构也较复杂，对安全有效地消融造成一定困难。随着高精密度标测系统和消融能量的发展，左心房房扑机制越来越清晰，这为左心房房扑实施有效透壁消融终止房扑提供了依据。
Abstract:
Atrial flutter is a common macro-reentrant arrhythmia which is closely related to atrial fibrillation, and they often coexist. Catheter ablation has become the first-line treatment for atrial flutter, but the recurrent rate of atrial arrhythmias remains high after long-term follow-up. Compared with typical right atrial flutter, the mechanism of left atrial flutter is more complicated, which is often related to left atrial fibrosis caused by various reasons. Moreover, the adjacent structures around the left atrium are complex, and how to safely and effectively achieve transmural ablation to terminate atrial flutter has become a problem for electrophysiologists. With the rapid development of 3D high-density electroanatomic mapping systems and ablation energy, the mechanism of left atrial flutter has become more and more clearly understood, and the success rate of treatment of left atrial flutter can be further improved.

参考文献/References:

[1] Naccarelli GV,Varker H,Lin J,et al. Increasing prevalence of atrial fibrillation and flutter in the United States[J]. Am J Cardiol,2009,104(11):1534-1539.

[2] Stempfel S,Aeschbacher S,Blum S,et al. Symptoms and quality of life in patients with coexistent atrial fibrillation and atrial flutter[J]. Int J Cardiol Heart Vasc,2020,29:100556.

[3] Granada J,Uribe W,Chyou PH,et al. Incidence and predictors of atrial flutter in the general population[J]. J Am Coll Cardiol, 2000,36(7):2242-2246.

[4] Brugada J,Katritsis DG,Arbelo E,et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)[J]. Eur Heart J,2020,41(5):655-720.

[5] Wasmer K,M?nnig G,Bittner A,et al. Incidence,characteristics,and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation[J]. Heart Rhythm,2012,9(10):1660-1666.

[6] Schoels W,Offner B,Brachmann J,et al. Circus movement atrial flutter in the canine sterile pericarditis model. Relation of characteristics of the surface electrocardiogram and conduction properties of the reentrant pathway[J]. J Am Coll Cardiol,1994,23(3):799-808.

[7] Shah D. ECG manifestations of left atrial flutter[J]. Curr Opin Cardiol,2009,24(1):35-41.

[8] Okumura K,Plumb VJ,Pagé PL,et al. Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram[J]. J Am Coll Cardiol,1991,17(2):509-518.

[9] Jani C,Arora S,Zuzek Z,et al. Impact of catheter ablation in patients with atrial flutter and concurrent heart failure[J]. Heart Rhythm O2,2021,2(1):53-63.

[10] Deisenhofer I,Estner H,Zrenner B,et al. Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation:incidence, electrophysiological characteristics,and results of radiofrequency ablation[J]. Europace,2006,8(8):573-582.

[11] Chae S,Oral H,Good E,et al. Atrial tachycardia after circumferential pulmonary vein ablation of atrial fibrillation:mechanistic insights, results of catheter ablation, and risk factors for recurrence[J]. J Am Coll Cardiol,2007,50(18):1781-1787.

[12] Giehm-Reese M,Lukac P,Kristiansen SB,et al. Outcome after catheter ablation for left atrial flutter[J]. Scand Cardiovasc J,2019,53(3):133-140.

[13] Vicera J,Lin YJ,Lin CY,et al. Electrophysiological and clinical characteristics of catheter ablation for isolated left side atrial tachycardia over a 10-year period[J]. J Cardiovasc Electrophysiol,2019,30(7):1013-1025.

[14] Cherian TS,Supple G,Smietana J,et al. Idiopathic atypical atrial flutter is associated with a distinct atriopathy[J]. JACC Clin Electrophysiol,2021,7(9):1193-1195.

[15] Saoudi N,Cosío F,Waldo A,et al. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases;a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology[J]. Eur Heart J,2001,22(14):1162-1182.

[16] Winkle RA,Moskovitz R,Mead RH,et al. Ablation of atypical atrial flutters using ultra high density-activation sequence mapping[J]. J Interv Card Electrophysiol,2017,48(2):177-184.

[17] Adrag?o P,Matos D,Costa FM,et al. A new electrophysiologic triad for identification and localization of the critical isthmus in atrial flutter[J]. Rev Port Cardiol (Engl Ed),2020,39(6):309-314.

[18] Hindricks G,Kottkamp H. Simultaneous noncontact mapping of left atrium in patients with paroxysmal atrial fibrillation[J]. Circulation,2001,104(3):297-303.

[19] Balt JC,Klaver MN,Mahmoodi BK,et al. High-density versus low-density mapping in ablation of atypical atrial flutter[J]. J Interv Card Electrophysiol,2021,62(3):587-599.

[20] Kapur S. Atypical flutter with atrial isochronal late-activation map correlating with the critical isthmus[J]. J Innov Card Rhythm Manag,2021,12(Suppl 1):20-21.

[21] Sulkin MS,Laughner JI,Hilbert S,et al. Novel measure of local impedance predicts catheter-tissue contact and lesion formation[J]. Circ Arrhythm Electrophysiol,2018,11(4):e005831.

[22] Lackermair K,Kellner S,Kellnar A,et al. Initial single centre experience with the novel Rhythmia? high density mapping system in an all comer collective of 400 electrophysiological patients[J]. Int J Cardiol,2018,272:168-174.

[23] Anter E,McElderry TH,Contreras-Valdes FM,et al. Evaluation of a novel high-resolution mapping technology for ablation of recurrent scar-related atrial tachycardias[J]. Heart Rhythm,2016,13(10):2048-2055.

[24] Sohns C,Saguner AM,Lemes C,et al. First clinical experience using a novel high-resolution electroanatomical mapping system for left atrial ablation procedures[J]. Clin Res Cardiol,2016,105(12):992-1002.

[25] Rottner L,Metzner A,Ouyang F,et al. Direct comparison of point-by-point and rapid ultra-high-resolution electroanatomical mapping in patients scheduled for ablation of atrial fibrillation[J]. J Cardiovasc Electrophysiol,2017,28(3):289-297.

[26] Nakamura K,Sasaki T,Take Y,et al. Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias[J]. Heart Rhythm,2020,17(2):250-257.

[27] Liebregts M,Wijffels MCEF,Klaver MN,et al. Initial experience with AcQMap catheter for treatment of persistent atrial fibrillation and atypical atrial flutter[J]. Neth Heart J,2022,30(5):273-281.

[28] di Cori A,Mazzocchetti L,Parollo M,et al. Clinical impact of high-density mapping on the acute and long term outcome of atypical atrial flutter ablations[J]. J Interv Card Electrophysiol,2022 Jan 17. DOI: 10.1007/s10840-022-01121-3. Online ahead of print.

[29] Vlachos K,Efremidis M,Derval N,et al. Use of high-density activation and voltage mapping in combination with entrainment to delineate gap-related atrial tachycardias post atrial fibrillation ablation[J]. Europace,2021,23(7):1052-1062.

[30] Wittkampf FH,van Oosterhout MF,Loh P,et al. Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation:histological analysis[J]. Eur Heart J,2005,26(7):689-695.

[31] Hamoud NS,Abrich VA,Shen WK,et al. Achieving durable mitral isthmus block:challenges,pitfalls,and methods of assessment[J]. J Cardiovasc Electrophysiol,2019,30(9):1679-1687.

[32] Lee JH,Nam GB,Go TH,et al. Alternative strategies to improve success rate of mitral isthmus block[J]. Medicine (Baltimore),2018,97(48):e13060.

[33] Yu J,Chen K,Yang B,et al. Peri-mitral atrial flutter:personalized ablation strategy based on arrhythmogenic substrate[J]. Europace,2018,20(5):835-842.

[34] Ho?da MK,Koziej M,Ho?da J,et al. Anatomic characteristics of the mitral isthmus region:the left atrial appendage isthmus as a possible ablation target[J]. Ann Anat,2017,210:103-111.

[35] Naniwadekar A,Koruth J. Impact of technique and technology on mitral isthmus ablation[J]. Curr Treat Options Cardiovasc Med,2019,21(9):46.

[36] Chiang SJ,Tsao HM,Wu MH,et al. Anatomic characteristics of the left atrial isthmus in patients with atrial fibrillation:lessons from computed tomographic images[J]. J Cardiovasc Electrophysiol,2006,17(12):1274-1278.

[37] Maurer T,Metzner A,Ho SY,et al. Catheter ablation of the superolateral mitral isthmus line: a novel approach to reduce the need for epicardial ablation[J]. Circ Arrhythm Electrophysiol, 2017,10(10):e005191.

[38] Hasegawa K,Miyazaki S,Kaseno K,et al. Ultrahigh resolution activation mapping of a left atrial macroreentrant tachycardia using a Marshall bundle epicardial connection[J]. J Cardiovasc Electrophysiol,2019,30(3):442-443.

[39] Nayak HM,Aziz ZA,Kwasnik A,et al. Indirect and direct evidence for 3-D activation during left atrial flutter:anatomy of epicardial bridging[J]. JACC Clin Electrophysiol,2020,6(14):1812-1823.

[40] Mizobuchi M,Yamashita T,Kobayashi T,et al. Unrecognized left atrial activation patterns of Marshall bundle-related atrial tachycardia following atrial fibrillation ablation[J]. HeartRhythm Case Rep,2020,6(8):543-546.

[41] Garcia F,Enriquez A,Arroyo A,et al. Roof-dependent atrial flutter with an epicardial component:role of the septopulmonary bundle[J]. J Cardiovasc Electrophysiol,2019,30(7):1159-1163.

[42] Arai T,Takahashi M,Hojo R,et al. Endocardial and epicardial activation maps for three-dimensional perimitral flutter using a three-dimensional mapping system:a case report[J]. Eur Heart J Case Rep,2021,5(10):ytab411.

[43] de Ponti R,Verlato R,Bertaglia E,et al. Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping:identification and ablation of the mid-diastolic isthmus[J]. Europace,2007,9(7):449-457.

[44] Pott A,Teumer Y,Weinmann K,et al. Substrate-based ablation of atypical atrial flutter in patients with atrial cardiomyopathy[J]. Int J Cardiol Heart Vasc,2022,40:101018.

[45] Mori?a-Vázquez P,Moraleda-Salas MT,Arce-León ?,et al. Effectiveness and safety of AV node ablation after His bundle pacing in patients with uncontrolled atrial arrhythmias[J]. Pacing Clin Electrophysiol,2021,44(6):1004-1009.

相似文献/References:

[1]简军 殷跃辉.APPLE评分与心房颤动[J].心血管病学进展,2020,(6):616.[doi:10.16806/j.cnki.issn.1004-3934.2020.06.014]
　JIAN Jun,YIN Yuehui.The APPLE Score and Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2020,(5):616.[doi:10.16806/j.cnki.issn.1004-3934.2020.06.014]
[2]范建华 刘庆军.高功率短时程射频消融治疗心房颤动的研究进展[J].心血管病学进展,2020,(8):806.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.006]
　FAN JIanhuaLIU Qingjun.High Power Short Duration Radiofrequency Ablation for Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2020,(5):806.[doi:10.16806/j.cnki.issn.1004-3934.2020.08.006]
[3]洪璐 曹明强 周亚峰.2016年ASE/EACVI指南评估的左室舒张功能对阵发性心房颤动术后复发的预测价值[J].心血管病学进展,2021,(5):464.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.019]
　HONG Lu,CAO Mingqiang,ZHOU Yafeng.Predictive Value of Left Ventricular Diastolic Function Assessed by 2016 ASE/EACVI Guidelines for Postoperative Recurrence of Paroxysmal Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2021,(5):464.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.019]
[4]赵震 孙雪荣 乔宇 郭雨龙 郭金锐 刘可 刘晨 刘帆 郭涛 牛国栋.心房颤动高功率短时程消融策略的研究进展[J].心血管病学进展,2021,(10):878.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.004]
　ZHAO Zhen,SUN Xuerong,QIAO Yu,et al.High-power Short-duration Ablation Strategy for Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2021,(5):878.[doi:10.16806/j.cnki.issn.1004-3934.2021.10.004]
[5]徐尧 蔡衡 李洪仕.射频消融与药物治疗对心房颤动合并心力衰竭患者的疗效差异比较[J].心血管病学进展,2022,(3):274.[doi:10.16806/j.cnki.issn.1004-3934.2022.03.000]
[6]李宸 章海燕 徐少华 许海南 张祖宏 龙明智.消融指数指导心房颤动射频消融的有效性和安全性的荟萃分析[J].心血管病学进展,2022,(2):171.[doi:10.16806/j.cnki.issn.1004-3934.2022.02.019]
　LI Chen,ZHANG Haiyan,XU Shaohua,et al.Efficacy and Safety of Radiofrequency Ablation of Atrial Fibrillation Guided by?blation Index: A Meta-Analysis[J].Advances in Cardiovascular Diseases,2022,(5):171.[doi:10.16806/j.cnki.issn.1004-3934.2022.02.019]

更新日期/Last Update: 2023-06-29