起源上腔静脉快速房性心律失常的电生理特征和射频导管消融治疗

Electrophysiologic characteristics and radiofrequency catheter ablation of atrial tachyarrhythmias originating from the superior vena cava

目的:分析上腔静脉起源的异位冲动诱发阵发性心房颤动(房颤)和房性心动过速(房速)的特点,总结射频导管消融电隔离上腔静脉治疗快速房性心律失常的经验。方法:连续收治快速房性心律失常患者108例,对经电生理检查证实房性心律失常起源于上腔静脉的11例患者行上腔静脉造影,明确上腔静脉开口位置后应用标测导管于上腔静脉进行激动标测,标测上腔静脉最早激动点及肌袖电位分布位置进行消融,直至房性心律失常终止及上腔静脉电位消失。结果:11例患者中,房速5例,房颤6例。5例房速患者上腔静脉房速发作周长为260～390ms;P波形态除1例判定不清外,其余4例均为Ⅰ、Ⅱ、Ⅲ、aVF、aVL导联直立,aVR导联倒置。6例房颤患者中,4例在环肺静脉隔离后仍可诱发或自发短阵房速或频发房性期前收缩,经标测起源于上腔静脉;2例术中自发房颤标测过程中发现上腔静脉电位频率较肺静脉电位频率更快。上腔静脉电隔离后,术中均成功终止心动过速。随访6～20个月,1例患者阵发性房颤复发,1例患者因窦性停搏行永久起搏器治疗。结论:上腔静脉是房速和房颤的起源部位之一,射频导管消融治疗有很高的成功率。

Objective：To analyze the clinical and electrophysiological characteristics of paroxysmal atrial fibrillation and atrial tachycardia initiated by ectopies from the superior vena cava （SVC）, and to evaluate the effects of electrical isolation of SVC with radiofrequency catheter ablation. Method： One hundred and eight atria tachya- rrhythmias patients who underwent catheter ablation were enrolled. Eleven patients which had eetopic beats originating from the SVC confirmed by electrophysiological were selected. SVC angiography was performed to visualize the junction between SVC and the right atrium. Activation map was then performed at multiple points by dragging the mapping catheter along the SVC. Radiofrequency applications were delivered at the location of earliest SVC activation and the muscle sleeve until the SVC potentials disappeared. Result-： Five patients were atrial tachycardia and six patients were atrial fibrillation. The cycle length of the atrial tachycardia was highly variable, ranging from 260 to 390 ms. The P wave of atrial ectopic beats was postive and tall in leads I , II , III , aVF, aVL and negative in leads aVR except that one patient had a vague P morphology. Four patients could be induced atrial premature beats or atrial tachycardia after isolation circumferential of pulmonary vein in atria fibrillation. The initiation of tachyarrhythmias by the ectopies was from the SVC. Two patients of them could be mapped more rapid frequence potential in SVC than other veins. During 6 to 20 months＇ follow-up, recurrence of patients was observed in one patient. One patient required permanent pacemaker implantation due to the sinus pause after SVC isolation. Conclusion：Atrial tachyarrhythmias may originate from SVC and be successfully cured with radiofrequency catheter ablation.