肌袖性房性心律失常——一种独特的房性心律失常?(Ⅰ)

Myocardial sleeve mediated atrial tachyarrhythmias——a specific atrial arrhythmia?(Ⅰ)

目的 提出房性心律失常的一个新命名———肌袖性房性心律失常。方法 总结 38例快速房性心律失常患者的临床和电生理资料。结果 心律失常类型有房性早搏、短阵或持续房性心动过速、短阵和持续心房扑动、阵发性和持续性心房颤动 ,且均为 2种以上的房性心律失常并存。发现这些心律失常与肺静脉和腔静脉的肌袖有关 ,并将这种由肌袖电活动 (肌袖产生的电冲动 )引起的心律失常命名为“肌袖性房性心律失常”。可分为 :①肌袖性房性早搏 ;②肌袖性房性心动过速 ;③肌袖性心房扑动 ;④肌袖性心房颤动 ;⑤肌袖性紊乱心房律。根据房性心律失常时的肌袖电活动特征及其与心房电活动的关系 ,可进一步分类为 :①肌袖性房性早搏 (驱动性 1∶1、非 1∶1驱动 ) ;②肌袖性房性心动过速 (驱动性 1∶1、非 1∶1驱动 ;触发性 ) ;③肌袖性心房扑动 (驱动性 1∶1、非 1∶1驱动 ;触发性 峡部依赖性、非峡部依赖性 ) ;④肌袖性心房颤动 (驱动性、触发性 ) ;⑤肌袖性紊乱心房律 (驱动性、触发性 )。结论 缠绕于肺静脉或腔静脉壁上的肌袖心肌组织发放的单个或连续、有序或无序的快速电冲动 ,可通过触发或驱动心房肌导致各种房性心律失常。这种房性心律失常有着自己独特的心电图、临床和电生理特点 ,将其进行分类和命名 。

Objective The aim of this paper is to raise a new nomenclature of atrial arrhythmia-the myocardial sleeve (MS) mediated atrial tachyarrhythmia.Method The clinical,electrocardiographic and electrophysiologic features of thirty-eight patients with atrial arrhythmias were investigated and analyzed.Results These arrhythmias included atrial premature contrction,atrial tachycardia,atrial flutter,atrial fibrillation and so on.More than two kinds of these arrhythmias appeared in a single patient.These atrial arrhythmias were originated from myocardial sleeves of pulmonary and caval veins,and called as MS mediated tachyarrhythmia.According to ECG features,MS mediated atrial tachyarrhythmia included MS mediated atrial premature contraction,atrial tachycardia, atrial flutter,atrial fibrillation and chaos atrial rhythm.Depending on the relationship between the electric activities of MS and atira,they were further divided into triggered tachyarrhythmia or drived tachyarrhythmia,and 1∶1 drived tachyarrhythmia or non-1∶1 drived tachyarrhythmia.MS in superior vena cava and pulmonary veins can give rise to a single pulse or continuous,organized or disorganized impulses,trigger or drive atria to produce various atrial arrhythmias.Conclusion This kind of arrhythmia has specific clinical,electrocardiographic and electrophysiologic features.A new nomenclature might have significance on clinical practice,cardiac electrophysiology,and electrocardiography.