主动脉无冠窦内和二尖瓣环-主动脉连接处射频导管消融局灶性房性心动过速

Radiofrequency catheter ablation of focal atrial tachycardia originating from the non-coronary aortic si- nus and the mitral annulus-aorta junction

目的报道13例主动脉无冠窦内和1例二尖瓣环一主动脉连接（MAAJ）处成功消融局灶性房性心动过速（房速），探讨该类房速的电生理特点及标测和消融方法。方法14例患者，男性3例女性11例，平均年龄（54．4±10．4）岁，均有阵发性房速病史。心房刺激诱发房速后，分析体表心电图P’波特点并于右心房进行激动标测，如果最早心房激动邻近希氏束附近，少数患者在此处消融，其他患者和上述消融不成功患者，经主动脉逆行途径，在无冠窦内标测和消融。如果消融不能成功，则经房间隔穿刺途径至左心房标测最早激动部位处消融。结果房速发作时体表心电图P’波明显变窄（77．8±14．4）ms。右心房激动标测均在希氏束附近标测到相对提前的心房激动，3例于此处消融失败。14例经主动脉逆行途径于无冠窦内标测到最早心房激动提前希氏柬处心房激动0～20．0（10．1±6．3）ms，13例于无冠窦内消融成功，包括1例改用盐水灌注导管后消融成功。1例经无冠窦消融失败后，经穿刺房间隔于MAAJ处标测到最早心房激动处消融成功。随访3～38个月，均无复发。结论对于具有窄P’波及标测右心房最早激动位于希氏束附近的局灶性房速，经主动脉逆行途径在无冠窦内标测和消融具有很高的成功率，经穿刺房间隔在左侧MAAJ处消融或应用盐水灌注导管无冠窦内消融可能进一步提高消融成功率。

Objective To investigate electrophysiological characteristics and catheter ablation in patients with focal atrial tachycardia （FAT） originating from the non-coronary aortic sinus （NCAS） or the mitral annulus-aorta junction （MAAJ）. Methods Fourteen consecutive patients （11 female, mean age 54 years old） with paroxysmal FAT were included. The surface electrocardiogram features of FAT were analyzed and activation mapping was performed during FAT to identify the earliest activation in the fight atrium. If the earliest activation in the fight atrium was located at the His bundle region, activation mapping and ablation were performed in NCAS. If FAT could not be eliminated in NCAS ,further mapping and ablation in the left atrium by transseptal puncture approach were performed. Results The P＇ wave duration （77. 8± 14. 4） ms during FAT was significantly shorter than the P wave duration during sinus rhythm （ P 〈 0.05 ）. Activation mapping in the right atrium showed that a relative earlier atrial activation was located at the His bundle region. Activation mapping from the NCAS demonstrated that the earliest atrial activation preceded the atrial activation at the His bundle by 0-20 （10. 1 ±6. 3） ms. FATs were eliminated after ablation in NCAS in 13 patients,including in 3 patients who had a failed ablation at right anterior septum and in one patient who had a successful ablation by using saline irriga- ted radiofrequency catheter. In one patient, FAT originating from MAAJ was eliminated by transseptal puncture approach. All patients were free of FAT without antiarrhymic drugs during a follow-up of 3-38 months. Conclusions FAT originating from NCAS or MAAJ had narrow P＇ wave and a relative earlier atrial activation near the His bundle region. Ablation in NCAS had a high success rate. Ablation using saline irrigated catheter and ablation at MAAJ might further increase the success rate.