CAJ | 학술논문

目的报道一组起源于左心耳局灶性房性心动过速(房速)的电生理特征和射频消融治疗.方法 9例患者中男性5例,平均年龄(21±9)岁,经心内电生理检查和射频消融证实为起源于左心耳的房速,对其电生理特点及射频消融进行分析.结果左心耳房速表现为无休止性或静脉滴注异丙肾上腺素诱发,程序刺激不能诱发或终止房速.左心耳房速有独特的体表心电图特征,所有患者P波Ⅰ、aVL导为负向,Ⅱ、Ⅲ、aVF导联P波高而直立.V_1导P波为直立或正负双向(以直立为主),V_2～V_6导P波为等电位线(5例)或<0.1 mV低幅直立(4例).常规心内标测,最早心房激动为CS远端.成功靶点处局部心房激动领先P波起始(36.7±7.9)ms.5例患者最终使用盐水灌注导管消融成功,随访(12 ±5)个月无房速复发.结论左心耳房速有独特的心电图特征和房内激动顺序,对这类房速盐水灌注导管可能是更好的选择,左心耳内局灶消融长期随访安全有效.
목적 보도일조기원우좌심이국조성방성심동과속(방속)적전생리특정화사빈소융치료.방법 9례환자중남성5례,평균년령(21±9)세,경심내전생리검사화사빈소융증실위기원우좌심이적방속,대기전생리특점급사빈소융진행분석.결과 좌심이방속표현위무휴지성혹정맥적주이병신상선소유발,정서자격불능유발혹종지방속.좌심이방속유독특적체표심전도특정,소유환자P파Ⅰ、aVL도위부향,Ⅱ、Ⅲ、aVF도련P파고이직립.V_1도P파위직립혹정부쌍향(이직립위주),V_2～V_6도P파위등전위선(5례)혹<0.1 mV저폭직립(4례).상규심내표측,최조심방격동위CS원단.성공파점처국부심방격동령선P파기시(36.7±7.9)ms.5례환자최종사용염수관주도관소융성공,수방(12 ±5)개월무방속복발.결론 좌심이방속유독특적심전도특정화방내격동순서,대저류방속염수관주도관가능시경호적선택,좌심이내국조소융장기수방안전유효.
Objective To analyze the electrophysiological characteristics and efficacy of radiofrequeney catheter ablation ( RFA ) of focal atrial tachycardia (AT) originating from the left atrial appendage (LAA). Methods Electrophysiologic study and RFA were performed in 9 patients (4 female)with focal AT originating from the LAA. Atrial appendage angiography was performed to identify the origin of AT. P waves were classified as negative, positive, isoelectric, or biphasic. Results The mean age was (21 ±9)years. AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing. A characteristic P-wave morphology and endocardial activation pattern were observed. Positive P-wave in inferior leads was seen in all patients, upright or biphasic ( +/- )component P wave was observed in lead V_1, isoelectric component or an uptight component P wave with low amplitude ( < O0 1 mV) was seen in lead V_2 - V_6. Earliest endocardial activity occurred at the distal coronary sinus (CS) in all patients. The earliest endocardial activation at the successful RFA site occurred (36. 7 ± 7.9 ) ms before the onset of P wave. RFA was successful in all 9 patients immediately post procedure. AT reoccurred in 2 patients within 1 month post RFA and AT disappeared post the 2nd-RFA. AT reoccurred in 1 patient and terminated after the 3rd RFA. At the final follow-up ( 12 ± 5 ) months, all 9 patients were free of arrhythmias without antiarrhythmic drugs. Conclusions The LAA is an uncommon site of origin for focal AT. The characteristic P wave and activation timing are suggestive for focal AT originating from the LAA. LAA focal ablation is safe and effective for patients with focal AT originating from the LAA.