起源于冠状静脉窦口附近的房性心动过速体表心电图特点和射频消融治疗

Electrocardiographic Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Arising from the Ostium of Coronary Sinus

【目的】阐述起源于冠状静脉窦口附近的房性心动过速（简称房速）体表心电图特点及射频消融结果。【方法】本组共6例起源于冠状静脉窦口的局灶性房速，冠状静脉窦口位置通过冠状静脉窦造影确定。如标测的最早激动点位于冠状静脉窦口周1cm范围以内的区域并在此消融成功，则认为心动过速是起源于冠状窦口的房速。【结果】6例房速均在冠状静脉窦口附近消融成功，靶点局部A波激动时间领先体表P波起点31～50（39±12）ms。本组房速体表P波具有以下特点：Ⅱ、Ⅲ、aVF导联P波呈负向波，Ⅰ导联呈等电位线或低幅正向波，aVL导联呈正向波，多数病例V1导联P波前半部分为等电位线，后半部分为正向波，胸前导联P波由右向左在V3～V5导联逐渐移行为负向。【结论】冠状静脉窦口附近是右房房速的一个重要起源点，其体表心电图有明确特征。

[Objective] To elucidate the electrocardiographic features and results of radiofrequency catheter ablation（RFCA） of atrial tachycardia （AT） arising from the ostium of coronary sinus（CS）. [Methods] Six patients with focal ATs arising from the ostium of the CS were enrolled in this study. In all patients, the ostium of CS was identified by contrast venography and tachycardia was considered to arise from the ostium of CS when earliest activation was recorded and successful ablation achieved within lcm of the ostium of CS. [Results] All the ATs were successfully abolished near the ostium of CS, endocardial atrial activation of the target sites preceded the onset of the P-wave by 31-50（39± 12）ms. The P waves were consistently inverted in inferior leads , negative or isoelectric in lead Ⅰ, and positive in lead aVL. Lead V1 showed an isoelectric component followed by an upright component in most patients and a transition to negative P waves in lead V3 to V5. [Conclusion] Focal AT arising from the ostium of CS is an important site of right AT origin with characteristic P wave morphology.