上腔静脉与界嵴起源心房颤动的电生理特点和导管消融

The electrophysiological characteristics and catheter ablation of atrial fibrillation originated from superior vena cava and crista terminalis

目的探讨上腔静脉与界嵴起源心房颤动(简称房颤)的电生理特点和导管消融。方法9例房颤患者,完成环肺静脉电隔离后根据电生理和ECG诊断房颤为上腔静脉与界嵴起源。上腔静脉起源进行上腔静脉电隔离,界嵴起源则局灶消融最早激动点。术后随访ECG和Holter。结果上腔静脉起源7例,其中仅2例可根据体表ECG诊断。腔内电生理均发现上腔静脉起源的快速激动触发或驱动房颤,均行上腔静脉电隔离治疗成功。界嵴上部起源2例,腔内电生理发现局灶激动触发房性早搏或房性心动过速,局灶消融均获成功。1例在隔离上腔静脉时出现一过性窦性停搏。结论少数房颤起源于上腔静脉与界嵴的异位灶,腔内电生理具有特征性,上腔静脉电隔离和局灶消融可以有效治疗此类房颤。

Objective To investigate the electrophysiological characteristics and catheter ablation of atrial fibrillation （AF） originated from superior vena cava （SVC） and crista terminalis （CT）. Methods Nine cases were diagnosed AF with SVC or CT origin by endocardial mapping and surface ECG after circumferential pulmonary vein isolation. SVC isolation were performed for AF originated from SVC, and focal ablation was performed for AF originated from CT. ECG and Hoher was applied during follow-up to evaluate the effectiveness. Results AF in 7 cases was found to be originated from SVC, but characteristic P＇ wave on surface ECG was identified in only 2 cases. Eletrophysiological study showed rapid activity from SVC triggered or drived AF, which was eliminated by SVC isolation. AF in 2 cases was originated from upper CT. The earliest active focus from upper CT triggered premature atrial beats or short runs of atrial tachycardia, which was obviated by focal ablation. One case experienced transient sinus pause during SVC isolation. Conclusions AF is minorly originated from SVC or CT , which is characteristic on endocardial mapping. SVC isolation or focal ablation could effectively eliminate such types of AF.