| Objective:The occurrence andu maintenance mechanism of Atrial arrhythmias(AA)is related to the remodeling atrial structure and remodeling.The undelying causes of atrial structural remodeling and electrical remodeling are various factors such as Myocardial fibrosis(MF),cardiac surgery and radiofrequency catheter ablation,it can cause low voltage or scar,which induce the loe voltage area.These diseased atrial sbstrate is easy to cause atrial arrhythmia.We could through the substrate mapping to know the actual situation bipolar voltage and determine the atrial substrate diseased degree,then formulate the a practical individualized strategy.The purpose of this clinical study is to use the NavX high density mapping technique to understand the actual atrial voltage by the substrate mapping.To explore the feasibility and safety of the improved treament of scar related atrial tachycardia under the guidance of three-dimensional substrate mapping.Methods: Continuous admissioned 77 cases of recurrent atrial tachycadia after radiofrequency ablation of atrial fibrrilation or atrial tachycardia in Department of Cardiaology,Anhui Provincial Hospital.All patients were required to recover sinus rhythm and have a substrate mapping,recorded the atrial voltage anatomu,measured low voltage area and scar zone,calculate the ratio of low voltage zone to total atrial area,and exclude all patients with low voltage area less than 10%.All enrolled patients were randomized divided into two groups,all patients were required to verify whether the recovery of pulmonsry vein potential,ensure isolation line is completely,the observation group with activation mapping guided ablation;study group were treated by through the low voltagearea to electrical barrier regionguided by the substrate mapping in sinu rhythm.All patients were followed up by outpatient or telephone,and with postoprative conventional oral anticoagulant drugs and antiarrhymic drugs,all patients need received ECG and Holter monitoring according the symptoms after catheter ablation.Then every 6 months examination was performed if there are no recurrence to compare the occurrence of atrial arrhythmia in each group.Results: There are 12(15.6%)patients of 77 cases recover to the sinu rhythm and no longer induced after pulmonary vein isolation.temination,25(19.5%)patients with intraoperative mapping LVZ area is less than 10%,we final selected 40 cases,19 cases in the observation group,21 cases in the research group,according to the established ablation strategy for each group to radiofrequency ablation surgery,all patients could not induce any tachycardia,immediate surgery succedd rate was 100%,There were no significant diffrence with fluoroscopy time(15.80 ± 5.78,P > 0.05)and operation time(113.93±31,P>0.05).No serious postoperative complications,follow-up(19.75±10.59)months,the study group had 5 cases recurrence atrial arrhythmia(4 cases atrial fibrillation,1 case atrial flutter),and 5 cases in observation group(2 cases atrial fibrillatin,3 cases atrial flutter).All the recurrent patients receive the operation and had not find any arrhythmia again.The successful subgroup of the study group was lower than that of the recurrent subgroup in the low voltage zone and ratio of the left atrial area(P<0.05).The proportion of the left atrial area in the subgroup of the observation group was lower than that in the recurrence subgroup(P<0.05).Conclusion: For the scar related atrial tachycardia caused by the myocardial fibrosis,it is a safe and effctive method that through the low voltagearea to electrical barrier regionguided by the substrate mapping in sinu rhythm,and it has certain advantage in hemodynamic and noninducible tachycardia patients.The magnitude of bipolar mean voltage and ratio of low voltage zone is closely related with the incidence of atrial arrhythmias after radiofrequency ablation.The degree of myocardial fibrosis has a certain value in precting the incidence of the atrial arrhythmia after ablation. |
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