射频消融治疗起源于主动脉无冠窦的房性心动过速的效果

The Radiofrequency Catheter Ablation in Patients with Atrial Tachycardia Originating from Non-Coronary Aortic Sinus

目的:探讨起源于主动脉无冠窦或其邻近组织的房性心动过速(房速)的电生理特性及射频消融治疗的效果。方法:选择阵发性房速患者10例,术中予心房或心室刺激诱发房速,分别在右心房、主动脉无冠窦内进行心房激动标测,分析体表心电图P波及窦性心律时P波特点,最后均于无冠窦内进行射频消融治疗。结果:心房刺激均能反复诱发和终止10例患者的房速,右心房的前间隔希氏束上部标测出相对提前的心房激动,但多次射频消融未成功,后于主动脉无冠窦内标测出心房激动较体表心电图提前,放电后终止10例房速的发作。房速时P波间期明显短于窦律时,差异有统计学意义(P<0.05)。术后随访(12.5±5.3)个月,均无房速复发及手术相关并发症出现。结论:经主动脉无冠窦内射频消融可作为治疗消融前间隔希氏束部位失败的一种新方法。

Objective： To investigate the electrophysiological characteristics and effects of radiofrequency catheter ablation in patients with atrial tachycardia （AT） originating from the non-coronary aortic sinus （NAS） or its adjacent tissues. Methods： Ten patients with paroxysmal AT were included in this study. After AT was induced by atrial or ventricular stimulation, the activation mapping was performed during AT to identify the earliest activation in the right atria and the NAS, meanwhile to analyzed the surface electrocardiogram features of the AT and the sinus rhythm, finally radiofrequency ablation application was delivered in NAS. Results： AT was easily reproducibly induced and terminated by atrial pacing in all 10 patients. Regular activation mapping in atria showed that a relative earlier atrial activation was located at the top of the His bundle of the anteroseptal region in the right atria, and failed to terminate AT by radiofrequency ablation. Through puncture femoral artery, mapping in the NAS demonstrated that an earlier atrial activation preceded the atrial activation at the surface electrocardiogram. AT was terminated during the radiofrequency ablation. All 10 patients were free of AT without antiarrhymic drugs during a follow-up of （12.5±5.3） months. No complications occurred in anyone of the 10 patients. The P wave duration was significantly shorter during AT than that of sinus rhythm （P 〈 0.05）. Conclusion： Mapping and ablation from the NAS can be used as a new approach when failed to radiofrequency ablation at the His bundle of the anteroseptal region.