起源于冠状静脉窦口的房性心动过速九例

Electrocardiographic characterization and radiofrequency ablation of atrial tachycardia arising from the ostium of the coronary sinus

目的报道9例起源于冠状静脉窦口附近的房性心动过速（简称房速）。方法回顾分析2005年11月至2009年1月行射频消融治疗的59例房速患者，发现9例起源于冠状静脉窦口。其定义为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。结果9例靶点局部A波激动时间领先体表P波起点39±12（30～53）ms。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～V6导联逐渐移行为负向。结论冠状静脉窦口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 report 9 cases with atrial tachycardia （AT） arising from the ostium of the coronary sinus （CS）. Methods Fifty-nine patients with focal ATs, who received radiofrequency catheter ablation（ RFCA）, were analysed retrospectively,which data were from Nov ,2005 to Jan,2009. AT of nine eases originated from the ostium of the CS. AT was considered to arise from the ostium of the CS when earliest activation was recorded and successful ablation achieved within 1 cm of the ostium of the CS. Results In nine patients ,the endocardial atrial activation of the taget sites preceded the onset of the P-wave by 39 ± 12（ 30 -53 ）ms . The P waves were consistently inverted in inferior leads , isoeleetrie or low amplitude positive in lead I, and positive in lead aVL , Lead V1 showed an isoeleetric component followed by an upright component in most patients and showed a transition to negative P waves in Lead V3 to V6. Conclusion The ostium of the CS is an important site of right AT ,which has characteristic P wave morphology.