起源于上腔静脉的心房颤动的电生理特点及射频消融

Atrial fibrillation originated from superior vena cava and its ablation

目的探讨上腔静脉起源的心房颤动(房颤)的临床及电生理特点。方法回顾过去2年来我中心经电生理证实的起源于上腔静脉的房颤病例,分析其体表心电图及心腔内电生理特点。结果期间共16例患者(男/女=12例/4例,平均年龄53·4±10·6岁,阵发性/持续性房颤=11例/5例)经电生理证实房颤起源于上腔静脉,占同期接受导管消融病例的2·9%(16/545)。16例患者中,仅2例可以根据体表心电图诊断房颤为上腔静脉起源,此2例在上腔静脉隔离后房颤终止。另外14例体表心电图不典型者,先行左心房消融后,继续右心房标测过程中见上腔静脉驱动,隔离上腔静脉后房颤终止、不被诱发。隔离上腔静脉的平均放电次数6±2次,平均操作时间10±3min。上腔静脉-右心房之间肌束连接平均为3±1束。随访期间仅1例于术后3个月时出现心房扑动样发作。术后除1例出现右侧股静脉穿刺点血肿外,无其他并发症。结论上腔静脉可为肺静脉、左心房之外重要的房颤起源部位。对于心电图不典型者,完成左心房消融后如房颤不终止或易被诱发,则应考虑到上腔静脉起源的可能。

Objective To investigate the clinical and electrophysiological characters of atrial fibrillation （AF） originated from superior vena cava （SVC）. Methods Patients with SVC-originated AF admitted into our centre during the past 2 years were retrospectively investigated, and their clinical and electrophysiological characters were systematically analyzed. Results The AF in 16 patients （ M/F = 12/4 cases, mean age of 53.4 ± 10. 6 years old, paroxysmal/persistent AF = 11/5 cases） were confirmed to be originated from SVC, who contributed to 2.9% （ 16/545 ） of total cases underwent AF ablation during the same period. Among the 16 cases, 2 patients were diagnosed as SVC-originated AF by surface ECG, and isolation of SVC terminated AF in these 2 patients. In the remaining 14 patients with non-classic surface ECG, AF or organized atrial tachycardia （Ata） still sustained after initial left atrial （LA） ablation. The sustainable AF and Ata were found to be driven by fast activations within SVC, and were terminated by isolation of SVC. The average applications and procedure time for isolating SVC were 6 ± 2 times and 10 ±3 minutes respectively. The average muscle connections between SVC and LA were 3 ± 1. After a mean period of 6-month-follow-up, only one patient recurred with organized Ata. Except femoral hematoma in one patient, no other complications were found. Conclusion In addition to pulmonary vein and LA, SVC could be the orgin of AF. Therefore, for patient with sustainable AF or organized Ata after initial LA ablation, SVC origin should be put under consideration.