天津医药

• 心血管疾病论坛 •    

射频消融治疗起源于主动脉无冠窦的房性心动过速的效果

张鹏,许静   

  1. 天津市胸科医院
  • 收稿日期:2011-07-18 修回日期:2011-10-12 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 许静

The Electrophysiological Characteristics and Radiofrequency Catheter Ablation in Patients with Atrial Tachycardia Originating from the Non-coronary Aortic Sinus or its Adjacent Tissue

  • Received:2011-07-18 Revised:2011-10-12 Published:2012-03-15 Online:2012-03-15

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摘要： 摘要 目的：探讨起源于主动脉无冠窦或其邻近组织的房性心动过速（房速）的电生理特性及射频消融治疗方法。方法：10例患者男性4例，女性6例，年龄50～71岁，平均（58.1±6.1）岁，阵发性房速病史（4.7±2.6）年。术中予心房或心室刺激诱发房速，分别在右心房、主动脉无冠窦内进行心房激动标测并分析体表心电图P′波及窦性心律时P波特点，最后均于无冠窦内进行射频消融治疗成功。结果：心房刺激均能反复诱发和终止10例患者的房速，房速的平均间期为（318.3±50.1）ms。右心房的前间隔希氏束上部标测出相对提前的心房激动，但多次射频消融未成功，后经穿刺股动脉，于主动脉无冠窦内标测出心房激动较体表心电图提前（55.8±5.6）ms，放电1～2次于10s内终止10例房速的发作。随访（12.5±5.3）个月，无一例房速复发及手术相关并发症出现。房速时P′波间期(73.1±3.8)ms明显短于窦性心律时P波间期（92.3±5.1）ms，差别有统计学意义（P<0.05）。结论：经主动脉无冠窦内射频消融可作为消融前间隔希氏束部位失败的一种新方法，且起源于主动脉无冠窦或其邻近组织的房速的P′波间期明显短于窦性心律时的P波，此特点可作为选择无冠窦内射频消融时的参考。

关键词: 主动脉, 房性心动过速, 无冠窦, 希氏束

Abstract: Abstract Objective: To investigate electrophysiological characteristics and radiofrequency catheter ablation in patients with atrial tachycardia(AT) originating from the non-coronary aortic sinus(NAS) or its adjacent tissue.Methods: Ten patients[6 female,4 males,the age from 50 to 71,mean age(58.1±6.1)years]with paroxysmal AT for (4.7±2.6)years were included. After ATs were induced by atrial or ventricular stimulation,the activation mapping was performed during AT to identify the earliest activation in the right atria and the NAS,meanwhile to analyzed the surface electrocardiogram features of the AT and the sinus rhythm,finally radiofrequency ablation application was delivered in NAS.Results:ATs with mean cycle length of (318.3±50.1)ms were easily reproducibly induced and terminated by atrial pacing in all 10 patients.Regular activation mapping in atria showed that a relative earlier atrial activation was located at the top of the His bundle of the anteroseptal region in the right atria,and failed to terminated AT.Through puncture femoral artery,mapping in the NAS demonstrated that an earlier atrial activation preceded the atrial activation at the surface electrocardiogram by(55.8±5.6)ms.ATs were terminated less than 10 seconds during the first or second radiofrequency ablation.All 10 patients were free of AT without antiarrhymic drugs during a follow-up of(12.5±5.3)months.No complications occurred in anyone of the 10 patients.The P′ wave duration(73.1±3.8)ms during AT was significantly shorter than the P wave duration(92.3±5.1)ms during sinus rhythm(P<0.05).Conclusion:Mapping and ablation from the NAS can be used as a new approach when failed to radiofrequency ablation at the His bundle of the anteroseptal region. The P′ wave duration during AT originating from the NAS or its adjacent tissue was significantly shorter than the P wave duration during sinus rhythm.By this characteristic can we select NAS as a reference when the AT was failed to ablate.

Key words: aortic, atrial tachycardia, non-coronary sinus, His bundle