起源于右心耳局灶性房性心动过速电生理特点及射频消融

Focal atrial tachycardias arising from the right atrial appendage：electrocardiographic and electrophysi- ologic characteristics and radiofrequency ablation

目的探讨起源于右心耳局灶性房性心动过速（RAAT）心电图、电生理特点及射频消融。方法138例经射频消融治疗的局灶性房性心动过速（房速）中有7例（5．0％）起源于右心耳，通过10极冠状静脉窦（CS）电极导管、高位右心房（HRA）电极导管、希氏束（HBE）电极导管和消融导管（ABL）记录其电生理检查结果、靶点位置，并记录和观察体表心电图房性P波形态（正向、负向、低平和双向）。结果7例RAAT患者平均年龄为（41．1±19．6）岁，病史（5．4±4．0）年，其中男性4例，女性3例。房速持续性4例，阵发性2例，通过心房程序刺激诱发1例。体表心电图房性P波形态特征：所有患者V，导联P波负向，绝大多数下壁导联P波正向或双向，胸前导联P波由负向逐渐变为正向。心内电生理检查提示房速时HRA处A波最早，有效消融靶点较体表心电图P波提前（38．4±12．6）ms。6例患者消融成功，其中4例使用盐水灌注消融导管，随访3～12个月无房速复发，未见并发症发生。结论RAAT相对少见（5．0％），有特殊的心电图和心内电生理表现，盐水灌注消融导管能提高消融成功率，远期效果好。

Objective This study was designed to analyze the characteristics of ectrocardiographic （ECG） and eleetrophysiologic （EP） characteristics and the results of radiofrequency ablation （RFA） in focal atrial tachycardias arising from the right atrial appendage （RAAT）. Methods Seven patients （5.0%） of 138 underwent RFA for focal atrial taehyarrhythmia （AT）arising from the right atrial appendage, endocardial earliest activation site and ECG（ 12 leads）were recorded through catheters from coronary sinus（CS） , high right atrium （HRA）, His bundle. The P waves were classified as negative, positive, isoeleetrie, or biphasic. Results The mean age was（41.1 ± 19. 6） years,four male,with symptoms（5.4 ±4.0） years. AT was incessant in 4 patients, spontaneous in 2 patients,and induced by programmed extrastimuli in one patient. The P waves in lead VI were negative in all patients, and transformed gradually to positive across the precordial lead. The amplitude of P wave in the inferior lead was low positive in the majority of patients. Mean activation time at the successful RFA was（38.4 ± 12. 6）ms. Irrigated catheters were used in four patients, RFA was effective in six patients during 3 - 12 months of follow-up. Conclusion The RAAT is an uncommom form of focal AT with has some ECC,and electrophysiologie eharacteristics. Irrigated ablation catheters is a usefull tool. Long-term success was aehieved with foeal ablation in all patients.