经主动脉无冠窦内射频消融局灶性房性心动过速

Radiofrequency catheter ablation of focal atrial tachycardia from the non-coronary aortic sinus

目的探讨起源于主动脉无冠窦或其邻近组织的局灶性房性心动过速(简称房速)心脏电生理特点及经射频导管消融方法。方法 13例患者男3例,女10例,年龄52.7±9.8岁,阵发性房速病史4.2±4.5年。心房刺激诱发房速后,分析体表心电图P′波特点并于右房及主动脉无冠窦内进行激动标测。均于无冠窦内进行射频消融治疗。结果 13例心房刺激均能反复诱发或终止房速,平均周长340.9±46.0ms,房速时P′波时限77.8±14.4ms,明显短于窦性心律时P波时限111.2±10.3ms(P<0.05)。常规激动标测,所有患者于His束处标测到相对提前的心房激动。经主动脉逆行方法 ,所有患者于无冠窦内标测到心房激动较His束处的心房激动提前9.3±6.1ms,放电1～2次于2～8s内终止房速。随访3～36个月,无复发病例及手术相关合并症。结论起源于主动脉无冠窦或其邻近组织的房速具有窄P′波及常规标测相对提前的心房激动位于His束处的特点。经主动脉无冠窦内标测消融是一种根治此类房速安全有效的方法 。

Objective To investigate eleetrophysiological characteristics and catheter ablation in patients with focal atrial tachyeardia （FAT） originating from the non-coronary aortic sinus （NAS） or its adjacent tissue. Methods Thirteen consecutive patients（ 10 female, 3 males, 52.7 ±9.8 years old） with paroxysmal FAT for 4.2 ±4.5 years were included. The surface electrocardiogram features of FAT were analyzed and activation mapping was performed during FAT to identify the earliest activation in the right atria and the NAS. Radiofrequency ablation application was delivered in NAS. Results FATs with mean cycle length of 340.9 ± 46.0 ms were easily reproducibly induced and terminated by atrial pacing in all 13 patients. The P＇ wave duration （77.8± 14.4ms） during FAT was significantly shorter than the P wave duration （ 111. 2 ± 10.3ms） during sinus rhythm （P 〈 0.05 ）. Regular activation mapping in atria showed that a relative earlier atrial activation was located at the His bundle region. The aortic root activation mapping demonstrated that the earliest atrial activation preceded the atrial activation at the His bundle by 9.3 ± 6.1 ms were recorded at NAS. FATs were terminated in 2 - 8 seconds during the first or second radiofrequency ablation in NAS. All patients were free of FAT without antiarrhymic drugs during a follow-up of 3 -36 months. No complications occurred in anyone of the 13 patients. Conclusions Narrow P＇ wave and a relative earlier atrial activation near the His bundle region are the two characteristics of FAT originating from NAS or adjacent tissue. Mapping and ablation in NAS can be used as a safe and effective approach for this kind of FAT.