用非接触心内膜激动标测系统对右房阵发性心房颤动起源与折返机制的初步研究

The Initial Study on The Origin And Reentrant Mechenism of Paroxysmal Atrial Fibrillation Arising From Right Atrium With Non-Contact Mapping System.

探讨右房心房颤动 (简称房颤 )的起源及折返机制 ,为射频消融治疗房颤提供指导。对阵发性房颤的病人用非接触心内膜激动标测系统 (EnSite30 0 0 )标测其驱动房颤的房性早搏 (简称房早 )的起源点、起始激动部位、房颤折返途径与传导方向。结果 :7例右房房颤 ,2例合并左房房颤。其中 5例房早有 3个起源点 :3例起源于上腔静脉(SVC)、下腔静脉 (IVC)和界嵴 (CT) ;1例起源于SVC、SVC口和CT ;另 1例起源于SVC、IVC和峡部 (IS)。 1例有 2个起源点 ,起源于SVC口和IVC。单源起源 1例 ,起源于CT。 7例共 8个房颤的折返驱动点 ,其分别为 :SVC、SVC口和CT各 2个驱动点 ;IVC和IS各 1个驱动点。右房房颤的折返部位主要位于SVC、CT和IS ,部分折返经过IVC ;而所有房颤的折返均经过SVC后壁与右房交界处向CT传导。结论 :①用EnSite30 0 0可以精确标测房颤的起源和折返途径 ,指导消融线的设计和评价消融后的线性阻断效果 ;②房颤的机制是房早驱动的心房内不规则折返 ;③驱动房颤折返的房早起源部位有 :CT、SVC、IVC和IS,分单源、双源和多源 ,但大部分位于心房的上部 :SVC和CT 。

To Study the origin and reentrant mechanism of atrial fibrillation(AF) arising from right atrium and to guide the treatment of atrial fibrillation by radiofrequency catheter ablation,we mapped the origin foci of atrial premature beats(APB) which induced AF,starting activation points,reentrant pathways and conduction directions with non contact mapping system(Ensite 3000) in patients with paroxysmal atrial fibrillation(PAF).Results:AF were arised from right atria in the 7 patients and simultaneously from left atria in 2 patients.There were three origins of APBs in 5 patients,among which in 3 patients APBs originated from superior clavicular vein (SVC),inferior clavicular vein(IVC) and crista terminalis(CT),and in 1 case,APBs from SVC?SVC orifice(SVCO) and CT,in another 1 from SVC?IVC and isthmus(IS).In 1 case,there were two origins of APBs which originated from SVC and IVC.In another 1 case,there was only one origin of APB arising from CT.There were eight starting activation points of reentry in the 7 patients with PAF in this study:Two starting activation points respectively in SCV?SCVO and CT,and one starting activation point in ICV and another in IS respectively.Reentries of PAF located in right atria mainly arised from SCV?CT and IS,and some of them passed through ICV,however,they all passed through the common border of the posterior wall of SCV and right atrium and then spread towards CT.Conclusions:①We can map the origin and reentrant pathways of PAF with EnSite 3000 and direct the design of ablation lines and evaluate the effect of linear severance after ablation;②The mechanism of AF is intra atrial irregular reentry which is driven by APB;③Origins of APB driving AF in this study are as follows:CT?SCV?ICV and IS,and the APB are single focal,bifocal or multifocal,and most APB are located in the upper part of atrium:SCV and CT,and multifocal.[ Chinese Journal of Cardiac Pacing and Electrophysiology, 2003,17(1):22～26]