全球精选文摘 - 大动脉转位并伴有Mustard或Senning术后baffle并发症患者的导管消融术

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大动脉转位并伴有Mustard或Senning术后baffle并发症患者的导管消融术

Catheter ablation in transposition of the great arteries with Mustard or Senning baffles

Khairy P, Van Hare GF 2009/5/31 18:19:25

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Heart Rhythm, 2009,

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Complete transposition of the great arteries (D-TGA) accounts for 5% to 7% of congenital heart defects. Although the arterial switch procedure has now replaced atrial redirection as the surgical procedure of choice, most adults today with D-TGA have had Mustard or Senning baffles. These surgeries involve extensive atrial reconstruction and predispose to sinus node dysfunction and atrial tachyarrhythmias. By 20 years after surgery, the prevalence of atrial tachyarrhythmias is approximately 25%, continues to increase with time, and is similar among patients with Mustard or Senning baffles. In our experience, intra-atrial reentrant tachycardia (IART) is the most common arrhythmia substrate, followed by nonautomatic focal atrial tachycardia (NAFAT) and atrioventricular (AV) nodal reentrant tachycardia. Accessory-pathway-mediated tachyarrhythmias and atrial fibrillation occur less frequently. Table 1 summarizes the arrhythmias encountered in D-TGA.

Sudden cardiac death is the most common cause of death in patients with D-TGA and Mustard or Senning baffles, with a risk that exceeds that of tetralogy of Fallot. Importantly, observational studies have linked atrial arrhythmias to increased risk of sudden death, and a multicenter study of implantable cardioverter-defibrillator recipients suggests that supraventricular arrhythmias may trigger ventricular arrhythmias. In IART, atrial tachycardia rates tend to be slower than with typical atrial flutter, leading to 1:1 conduction, which in turn may result in hemodynamic instability. This phenomenon is potentially compounded by ineffective atrial transport, subendocardial ischemia of the systemic right ventricle, and systemic ventricular dysfunction. Therefore, an aggressive management strategy to prevent rapidly conducting atrial tachyarrhythmias is generally advisable. Catheter ablation is often considered the definitive treatment of choice.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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