His束旁起源房性心动过速的电生理特征及射频消融

The electrophysiological characteristics and strategies for catheter ablation of atrial tachycardia originating near the His bundle region

目的回顾性分析His束旁房性心动过速(简称房速)的心电生理特征并探讨射频消融策略。方法连续入选经心电生理检查和射频消融证实起源点位于His束旁的房速,对患者的临床特征、心电生理特点及射频消融策略进行回顾性分析。结果共入选23例,其中男7例,女16例,年龄(59.9±16.6)岁,病史6个月至5年。His束旁房速女性较男性多见,20例为阵发性,3例为无休止心动过速。所有患者的心电图特征为:P波窄而低幅,Ⅱ、Ⅲ、aVF和V1导联P波负正双向,Ⅰ、aVL导联直立,V2~V6导联P波负向。右房激动标测示心内最早激动位于His束附近,仅比冠状窦近端提前(15±3)ms(始终找不到最早提前的A波),20例于右房His束旁消融成功,3例于主动脉无冠窦内消融成功,均无并发症。结论His束旁房速有独特的心电图特征及心房内激动顺序,经右房His束旁消融治疗是安全有效的方法。

Objective Analyze the electrophysiological characteristics of the para-Hisian atrial tachycardia(AT)and the radiofrequency ablation results.Methods The electrophysiological examination and radiofrequency ablation confirmed the origin site of AT was located at the para-Hisian were included.The clinical characteristics,electrophysiological characteristics and radiofrequency ablation results were analyzed.Result The patients(n=23,male 7,female 16,aged 59.9±16.6years old)with para-Hisian AT for 6months to 5years were included,The number of women was more than that of the male,20were paroxysmal AT,and 3were endless AT.The electrocardiographic characteristics of all patients were:P wave was narrow and low amplitude,P wave were negative-positive bidirection inⅡ,Ⅲ,aVF and V1leads,upright in lead I and lead aVL and negative in V2-V6leads.The activation mapping in right atrial showed the earliest activation was near the His bundle,only(15±3)ms earlier than that of the proximal coronary sinus(the earliest advance A wave could not be found),and 20cases were successfully ablated by the right atrium.Three cases were successfully ablated in the non-coronary sinus,and no complications were found.Conclusion The para-Hisian AT has a unique electrocardiographic characteristics and atrial activation sequence.the para-Hisian AT ablation treatment through right atrial is safe and effective.