无冠窦起源房速的电生理特征与射频消融

Electrophysiological characterization and radiofrequency ablation of focal atrial tachycardia from non-coronary sinus

目的进一步分析起源于主动脉无冠窦房性心律失常的心电生理特征及射频消融治疗。方法11例患者经心内电生理检查和射频消融证实的起源于主动脉无冠窦局灶性房速，对其临床特征，心电生理特点及射频消融进行分析。结果无冠窦房速大多为女性，表现为阵发性，为心房或心室程序刺激诱发和终止。所有患者房速心电图P波窄而低幅，Ⅱ，Ⅲ，aVF和v，导联P波负正双向，Ⅰ，aVL导联直立，V2～V6导联P波负向。心内最早激动位于希氏束远端，并领先于体表P波起始（15±3）ms。无冠窦内标测最早激动等于或早于希氏束远端，局部电位特征为大A小V（或大V），无希氏束电位，11例患者无冠窦内放电均在8秒内终止心动过速，均无并发症，无抗心律失常药物随访12±5月所有患者均无心动过速复发。结论主动脉无冠窦房速有独特的临床特征，心电图特征及心房内激动顺序，长期随访这类房速射频消融有良好的治疗效果。

Objective To report successful catheter ablation of focal atrial tachycardia from non-coronary aortic sinus. Methods 11 patients （9 female, 2male） undergoing RFA with focal AT from non-coronary aortic sinus underwent electrophysiologiea] study and radiofrequency catheter ablation procedures. The location of the non-coronary aortic sinus was defined by local electrocardiograms, anatomic findings under fluoroscopic guidance and angiography of the aortic root. Results All AT was reproducibly induced by atrial or ventricular pacing. The P-wave morphology was significantly narrower than the P wave during sinus rhythm with low amplitude during tachycardia （80 ± 15 vs. 118 ± 26ms） （p〈0.05）. The P-wave in inferior leads and lead V1 was biphasic （-/＋） component in all patients. The P-wave in lead I and aVL were positive in these 11 patients. Lead V2-V6 showed a negative component. Earliest endocardial activity occurred at the distal His bundle and preceded the onset of P-wave by l 5 ± 3 ms. RFA in non-coronary aortic sinus was acutely suceessfill in all 11 patients. His potentials were not found at the successful site in the non-coronary sinus in all 11 patients. The focal AT was terminated in 8 s in all 11 patients. No complications occurred in any of the 11 patients. All 11 patients were free of arrhythmias without anti-arrhythmic drugs during a follow-up of 12 ± 5 months. Conclusions In patients with focal AT near the HB region, mapping in the non-coronary AS can improve clinical outcome. It can be suspected as a potential anatomic site of AT origin from the characteristic P wave and atrial activation sequence.