希氏束旁起源房性心动过速心电生理特征及射频消融疗效

Electrophysiological characteristics and curative effect of radiofrequency ablation in patients with para-Hisian atrial tachycardia

目的：分析起源于希氏束旁房性心动过速（房速）的心电生理特征及射频消融治疗效果。方法选自2009年1月至2014年5月在首都医科大学附属北京安贞医院心内科就诊的经心内电生理检查和射频消融证实起源点位于希氏束旁的房速，简称希氏束旁房速18例，其中男2例，女16例，年龄31-68（40±9）岁，病史1-10年。对患者临床特征、心电生理特点及射频消融疗效进行分析。结果希氏束旁房速大多为女性，16例表现为阵发性，为心房或心室程序刺激诱发和终止，2例为无休止心动过速。所有患者房速心电图P波窄而低幅，Ⅱ，Ⅲ，aVF和V1导联P波负正双向，Ⅰ、aVL导联为直立，V2-V6导联P波负向。右房激动标测示心内最早激动位于希氏束附近，并领先于体表P波起始（15±3）ms。16例患者于无冠窦内消融成功，2例于右房希氏束旁消融成功，均无并发症，随访12个月所有患者均无心动过速复发。结论希氏束旁房速有独特的临床特征，心电图特征及心房内激动顺序，应首选无冠窦途径消融，长期随访房速行射频消融治疗安全有效。

Objective To analyze electrophysiological characteristics and curative effect of radiofrequency ablation in patients with para-Hisian atrial tachycardia （AT）.Methods The patients （n=18, male 2, female 16, aged from 31 to 68 and average age： 40±9） with para-Hisian AT for 1 y to 10 y were chosen from Jan. 2009 to May 2014. The clinical features, electrophysiological characteristics and curative effect of radiofrequency ablation were analyzed.Results The most of patients were female, among them 16 had paroxysmal AT reduced and stopped by atrial or ventricular programmed stimulation, and 2 had endless AT. In all patients, P wave was narrow with low amplitude, positive-negative biphasic in lead II, lead III, lead aVF and V1, upright in lead I and lead aVL, and negative phasic in leads V2-V6. The right atrial activation mapping showed that the earliest cardiac activation was occurred around Hisian bundle, and faster than surface P wave onset by （15±3） ms. There were 16 cases with successful aortic non-coronary sinus ablation and 2 with successful para-Hisian ablation, and all of them had no complications. After followed up for 12 m, all patients had no reoccurrence of AT.Conclusion The para-Hisian AT has special clinical features, electrophysiological characteristics and atrial activation program. The aortic non-coronary sinus ablation should be selected at first in the treatment. A long-term follow-up has proved that radiofrequency ablation is safe and effective to AT.