射频消融治疗心房肌肌袖相关的房性心动过速

Focal atrial tachycardia:arrhythmias from atrial muscular sleeve

目的 研究房性心动过速 (房速 )的临床和电生理特点。方法 病例为 1998年 1月～2 0 0 1年 4月在我院因房速 [部分伴心房颤动 (房颤 ) ]而行心内电生理和射频消融的患者。比较不同部位起源房速的临床特点和心内激动差异。结果 共 19例 ,年龄 (4 6 8± 18)岁。尝试消融治疗 16例 ,房速起源右房侧 11例 ,分别为希氏束上方 4例 ,上腔静脉、右心耳各 2例 ,下腔静脉、冠状窦口、终末嵴各 1例。起源于左房侧 5例 ,分别为肺静脉 4例 ,左心耳 1例。消融成功 13例 (81%) ,不成功者分别为希氏束旁 2例 ,肺静脉 1例。左房起源和上腔静脉起源房速心电图aVL导联P波呈负相 ,不同之处是后者Ⅰ导联P波呈正相。左上肺静脉、左心耳和上腔静脉起源的房性早搏 (房早 )和房速冠状窦远端心房激动早于或等于冠状窦口。而右上肺静脉房早和房速的冠状窦口激动早于远端。左上肺静脉、冠状窦口和下腔静脉的房早和房速时的冠状窦口激动早于右房上部。其他起源房早和房速时的右房上激动早于冠状窦口。成功消融部位电位提前体表心电图的P波 (37 6± 16 6 )ms。但肺静脉和上腔静脉心动过速病例中各有 1例经消融隔离心动过速起源的远端而成功。虽然多数患者的心动过速起源于易形成肌袖的心房和血管交界部位 ,但是肺静脉起源房速 [AA?

Objective To evaluate the clinical and electrophysiological features of atrial tachycardia (AT) initiating from focal atrial ectopies. Methods Patients admitted for electrophysiological evaluation and catheter ablation of AT from January 1998 to April 2001 were included in the study. Sixteen of nineteen cases, aged 46.8±18, were attempted for ablation of precipitating atrial foci. There were 4 in pulmonary veins (PV) and 4 in para-Hisian, 2 in superior vena cava (SVC) and 2 in right atrium appendage (RAA), and one each in inferior vena cava (IVC), coronary sinus ostiun(CS-os), crista teminalis and left atrium appendage (LAA). Thirteen of sixteen cases were successfully ablated. The failed 3 cases were 2 from para-Hisian and one from PV. Results The time interval between CS-os and distal was ≤0 ms in the patients with AT from left PV, LAA, and SVC. All AT except those from left PV, CS-os and IVC had atrial activation earlier in high right recording than in CS-os. The frequency of AT was faster in patients with PV foci[(230.8±58.0)ms] than in others [(342.6±86.5)ms, P=0.015]. The patients with AT from PV are more likely to have atrial fibrillation clinically (4/4). The local activation of successful ablation sites was (37.6±16.6)ms earlier than P wave on ECG. One AT from left PV and one from SVC could only be cured with isolating distal PV and SVC. Conclusions AT is likely to initiate from junction of atrial and large vessels where atrial muscular sleeves may exist. Routine intracardiac mapping can roughly disclose the origin of AT. The cure of AT with catheter ablation is feasible.