中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2014年
1期
35-40
,共6页
欧阳静娥%王祖禄%李世倍%梁延春%杨桂棠%金志清%于海波%梁明%韩雅玲
歐暘靜娥%王祖祿%李世倍%樑延春%楊桂棠%金誌清%于海波%樑明%韓雅玲
구양정아%왕조록%리세배%량연춘%양계당%금지청%우해파%량명%한아령
局灶性房性心动过速%后间隔%冠状静脉窦%体表心电图%射频导管消融
跼竈性房性心動過速%後間隔%冠狀靜脈竇%體錶心電圖%射頻導管消融
국조성방성심동과속%후간격%관상정맥두%체표심전도%사빈도관소융
Focal atrial tachycardia%Posterior septum%Coronary sinus%Electrocardiogram%Radiofrequency catheter ablation
目的 探讨起源于心房后间隔及邻近区域局灶性房性心动过速(房速)心脏电生理特点及射频导管消融特点.方法 入选23例患者,男12例,女11例,平均年龄(48.3±19.3)岁,自发或心房程序刺激诱发房速后,分析体表心电图P'波特点并于后间隔各个部位进行激动标测和射频消融治疗.结果 23例心房刺激均能反复诱发或终止房速,平均周长(346.7±61.8) ms,房速时P'波时限明显短于窦性心律时P波时限[(86.2±14.0)ms对(115.4±19.9) ms,P＜0.05].体表P'波表现为Ⅰ导联多呈等电位线,下壁导联呈深倒负向波,aVR和aVL导联呈正向波,V3～W5导联呈负向波.常规激动标测,所有患者于冠状静脉窦口(CSO)附近标测到相对提前的心房激动,其中12例起源于右后间隔,6例起源于CSO及近端,2例起源于心中静脉,3例起源于左后间隔.靶点提前体表P'波平均(34.4±18.0) ms,放电开始至心动过速终止时间为(6.2±4.2)s,11例患者放电过程中出现交界区心律.所有患者均消融成功,其中3例需应用盐水灌注导管.随访4个月～ 10年,无复发病例及手术相关并发症.结论 后间隔局灶性房速P'波形态具有特异性,对导管消融定位意义较大.由于解剖的复杂性,部分病例标测和消融困难,需结合右心房后间隔、冠状静脉窦(CS)内和/或其分支、左心房后间隔等多部位标测和/或消融方能获得成功.
目的 探討起源于心房後間隔及鄰近區域跼竈性房性心動過速(房速)心髒電生理特點及射頻導管消融特點.方法 入選23例患者,男12例,女11例,平均年齡(48.3±19.3)歲,自髮或心房程序刺激誘髮房速後,分析體錶心電圖P'波特點併于後間隔各箇部位進行激動標測和射頻消融治療.結果 23例心房刺激均能反複誘髮或終止房速,平均週長(346.7±61.8) ms,房速時P'波時限明顯短于竇性心律時P波時限[(86.2±14.0)ms對(115.4±19.9) ms,P＜0.05].體錶P'波錶現為Ⅰ導聯多呈等電位線,下壁導聯呈深倒負嚮波,aVR和aVL導聯呈正嚮波,V3～W5導聯呈負嚮波.常規激動標測,所有患者于冠狀靜脈竇口(CSO)附近標測到相對提前的心房激動,其中12例起源于右後間隔,6例起源于CSO及近耑,2例起源于心中靜脈,3例起源于左後間隔.靶點提前體錶P'波平均(34.4±18.0) ms,放電開始至心動過速終止時間為(6.2±4.2)s,11例患者放電過程中齣現交界區心律.所有患者均消融成功,其中3例需應用鹽水灌註導管.隨訪4箇月～ 10年,無複髮病例及手術相關併髮癥.結論 後間隔跼竈性房速P'波形態具有特異性,對導管消融定位意義較大.由于解剖的複雜性,部分病例標測和消融睏難,需結閤右心房後間隔、冠狀靜脈竇(CS)內和/或其分支、左心房後間隔等多部位標測和/或消融方能穫得成功.
목적 탐토기원우심방후간격급린근구역국조성방성심동과속(방속)심장전생리특점급사빈도관소융특점.방법 입선23례환자,남12례,녀11례,평균년령(48.3±19.3)세,자발혹심방정서자격유발방속후,분석체표심전도P'파특점병우후간격각개부위진행격동표측화사빈소융치료.결과 23례심방자격균능반복유발혹종지방속,평균주장(346.7±61.8) ms,방속시P'파시한명현단우두성심률시P파시한[(86.2±14.0)ms대(115.4±19.9) ms,P＜0.05].체표P'파표현위Ⅰ도련다정등전위선,하벽도련정심도부향파,aVR화aVL도련정정향파,V3～W5도련정부향파.상규격동표측,소유환자우관상정맥두구(CSO)부근표측도상대제전적심방격동,기중12례기원우우후간격,6례기원우CSO급근단,2례기원우심중정맥,3례기원우좌후간격.파점제전체표P'파평균(34.4±18.0) ms,방전개시지심동과속종지시간위(6.2±4.2)s,11례환자방전과정중출현교계구심률.소유환자균소융성공,기중3례수응용염수관주도관.수방4개월～ 10년,무복발병례급수술상관병발증.결론 후간격국조성방속P'파형태구유특이성,대도관소융정위의의교대.유우해부적복잡성,부분병례표측화소융곤난,수결합우심방후간격、관상정맥두(CS)내화/혹기분지、좌심방후간격등다부위표측화/혹소융방능획득성공.
Objective To investigate the electrocardiographic and electrophysiological characteristics and the effect of radiofrequency catheter ablation of focal atrial tachycardia(FAT) in posterior septum(PS) and nearby region.Methods Twenty-three consecutive patients (11 females,mean age 48.3 ± 19.3 years) with paroxysmal FAT originating from PS and nearby region were included.The surface electrocardiogram features of FAT were analyzed and activation mapping was performed during FAT to identify the earliest activation sites in PS and adjacent sites.Radiofrequency catheter ablation (RFCA) was delivered at the site with earliest activation.Results The average cycle length of FAT was (346.7±61.8) ms.The P' wave duration during FAT was significantly shorter than that during sinus rhythm [(86.2± 14.0) ms vs.(115.4± 19.9) ms,P＜0.05)].The P'wave morphologies were nearly isoelectric in lead Ⅰ,deeply negative in all inferior leads,positive in lead aVR and aVL,negative in lead V3-V5.Activation mapping in the right atrium showed that the site with earlier atrial activation was located close to the PS.Successful ablation was achieved in all the 23 patients.FATs were eliminated by RFCA in right PS(RPS) in 12 patients,coronary sinus(CS) ostium or proximal CS in 6 patients,middle cardiac vein in 2 patients,left PS(LPS) in the rest 3 patients.The earliest atrial activation time at the target sites preceded the onset of surface P' wave by (34.4± 18.0)ms.It took about (6.2±4.2) s to successfully ablate FAT.Junctional rhythm occurred in 11 patients during ablation.Long-term success was achieved in all patients during a period of 4 months to 10 years follow-up without complications.Conclusion The P' wave morphologies of FAT originating from PS could be helpful to locate the origins.Sometimes mapping and ablation of FAT adjacent to the area were very diffficult.Combination of mapping and ablation in RPS,within the CS and its branch,or in LPS was important to eliminate FAT of PS in some patients.
