右心房异常是心房扑动的病理基础——三维电—解剖标测结果

Anatomic Abnormality of the Right Atrium is an Important Substrate for Atrial Flutter — A Result of Electro-Anatomical Mapping

目的 :应用三维电—解剖标测技术标测典型心房扑动患者的右心房 ,并与房室结折返性心动过速患者比较 ,研究心房扑动患者右心房的解剖及电生理异常情况。方法 :2 0例心房扑动患者 [心房扑动组 ,男 16例 ,女 4例 ,平均年龄 ( 5 5 90± 10 68)岁 ]和 2 6例房室结折返性心动过速患者 [对照组 ,男 9例 ,女 17例 ,平均年龄 ( 4 7 5 0± 19 5 6)岁 ]在行射频导管消融前先用电—解剖标测进行研究 ,测量右心房容积 ,下腔静脉—三尖瓣环峡部 (CTI)的长度、宽度和右心房的单极和双极电压等 ,并对心房扑动组和对照组的各项参数进行比较。结果 :各项测量参数在心房扑动组和对照组分别为 :右心房容积 ( 14 3 2 2± 40 72 )mlvs ( 10 4 3 5± 2 1 0 6)ml;峡部长度 ( 3 9 3 1± 8 10 )mmvs ( 3 2 42± 9 77)mm ,峡部宽度 ( 3 0 5 4± 7 48)mmvs ( 2 3 15± 6 61)mm ,右心房单极电压 ( 1 96± 1 2 4)mVvs ( 1 5 3± 0 91)mV及右心房双极电压 ( 1 47± 1 47)mVvs ( 1 2 9± 1 12 )mV。以上各参数心房扑动组和对照组比较 ,P均 <0 0 5～ 0 0 1。结论 :心房扑动与房室结折返性心动过速患者相比 ,其右心房容积增大 ,CTI的长度和宽度增大 ,右心房的单极和双极电位增高。心房扑动患者的这些异常表现提示右心房增大。

Objectives:To map the right atrium in patients with atrial flutter (AFL), compare the results with those in patients with atrioventricular nodal reentrant tachycardias (AVNRT,as control group),and to investigate the anatomical and electrophysiological abnormality of the right atrium in AFL. Methods:The anatomy and electrophysiology of the right atrium and cavotricuspid isthmus were evaluated in 20 patients with AFL (16 M/4 F,mean age 55.90±10.68 yrs) and 26 patients with AVNRT (9 M/17 F,mean age 47.50±19.56 yrs) during coronary sinus pacing at 600 ms prior to ablation with electro-anatomical mapping system. The right atrial volume,the length and width of the cavotricuspid isthmus,the unipolar and bipolar voltage in the right atrium were measured and compared between patients with AFL and AVNRT. Results:Right atrial volume,the length and width of the cavotricuspid isthmus,the unipolar and bipolar voltage in the right atrium were 143.22±40.72 ml vs 104.35±21.06 ml,39.31±8.10 mm vs 32.42±9.77 mm,30.54±7.48 mm vs 23.15±6.61 mm,1.96±1.24 mV vs 1.53±0.91 mV and 1.47±1.47 mV vs 1.29±1.12 mV in AFL and AVNRT patients respectively. Conclusions:The right atrial volume is larger,both the length and width of cavotricuspid isthmus are greater,and unipolar and bipolar voltages in the right atrium are higher in AFL than in AVNRT,suggesting that the enlarged right atrium,increased length and width of cavotricuspid isthmus,and concomitant atrial hypertrophy are important substrates for initiation and perpetuation of typical AFL.