摘要目的 在三尖瓣-下腔静脉峡部(CTI)依赖性心房扑动(房扑)患者中,采用三维系统指导下右心房高密度标测(HDM),评价线性消融后裂隙情况及CTI双向传导(TIC)时间≥130 ms对CTI完全双向阻滞的预测价值.方法 本研究为前瞻性、单臂、开放性的多中心临床研究,入选2014年12月至2016年7月7个中心连续39例CTI依赖性房扑患者,年龄(56.58±11.73)岁,男31例.记录峡部线性消融后冠状静脉窦口与右心房低位游离壁双向传导时间,以及起搏时HDM所示右心房激动顺序是否为单一方向及消融线上有无裂隙各自的发生例数.计算峡部双向传导时间≥130 ms对诊断峡部完全阻滞的灵敏度、特异度、阳性预测值及阴性预测值.结果 23例CTI双向传导时间≥130 ms的患者中有10例HDM存在裂隙,16例<130 ms的患者中有14例HDM出现裂隙.峡部传导时间≥130 ms作为CTI完全性阻滞判断标准的灵敏度、特异度、阳性预测值及阴性预测值分别为86. 67%、58.33%、56.52%、87.5%.24例存在传导裂隙患者中有14例裂隙部位为欧氏嵴侧,4例为三尖瓣环侧,1例为两侧均出现,5例未记录补点消融部位.结论 峡部传导时间≥130 ms不宜单独作为CTI完全双向传导阻滞的判断标准,右心房HDM可为更可靠的标准.消融后裂隙部位常见于欧氏嵴区域.

abstractsObjective The purpose of this study was to evaluate the predictive strength using the criterion of trans-isthmus conduction(TIC) time of≥130 ms post ablation of typical atrial flutter(AFL) for complete bidirectional conduction block,which was confirmed with high-density mapping(HDM) of right atrium. Methods This was a prospective,single-arm and open multicenter study. The patients,aged (56.58±11.73)years,31 males,referring for cavotricuspid isthmus(CTI)-dependent AFL ablation were consecutively enrolled between December,2014 and July,2016. TIC intervals between the coronary sinus ostium (CSO)and low lateral right atrium(LRA)were recorded after ablation. Complete CTI block was determined by HDM of the right atrial activation. The sensitivity,specificity,positive and negative predictive values were calculated for the criterion of TIC time of≥130 ms. Results After the initial CTI ablation,conduction gaps in the ablation line were found in 10 of the 23 patients with TIC time≥130 ms and 14 of the 16 patients with TIC time <130 ms. The criterion of using bidirectional TIC time≥130 ms predicted complete CTI block with 86.67% sensitivity and 58.33% specificity. The positive and negative predictive values were 56.52% and 87.5%,respectively. Of the 24 cases with conduction gaps post ablation,14 were found on Eustachian valve(EV),4 on the tricuspid valve end of the CTI,1 on the both end and 5 were not available. Conclusions The study suggests that TIC time of≥130 ms should not be used as a criterion for complete bidirectional conduction block of CTI after liner ablation and that HDM can be a more reliable criterion. The EV end of the CTI is the most common site for conduction gaps.