| 摘要: |
| 目的 分析上腔静脉起源房性早搏、心房纤颤(房颤)的体表心电图及心内电生理特点,探讨上腔静脉起源房颤的电生理机制。 方法 回顾2006年9月至2010年8月收治的12例经电生理证实上腔静脉起源阵发性房颤患者,男/女=9/3,平均年龄(55.3±12.2)岁,分析诱发房颤的房性早搏及房颤的心电图特征,以及CARTO指导下隔离上腔静脉所需操作时间、消融点数、并发症和手术成功率。 结果 与窦性P波相比,上腔静脉起源房早P波在Ⅱ导联幅度更高 ,在V1导联呈现正负双向的比例更高(91.6% vs 33.3%, P<0.05),房颤波形态与房早及窦性P波相似(66.6%,8/12)。与隔离左上肺静脉相比,隔离上腔静脉所需操作时间 、消融点数(14±6 vs 36±11, P<0.05)明显减少,上腔静脉隔离后腔内电位仍显示快速激动8例,术后1个月内有2例患者出现阵发房扑,经药物控制后好转,所有患者均无并发症。 结论 上腔静脉起源房早及房颤具有独特的体表心电图特点,有助于术前预测靶静脉,上腔静脉电隔离所需时间及消融点数少,成功率高。 |
| 关键词: 上腔静脉 心房颤动 心房早搏 射频消融术 电生理学 |
| DOI：10.3724/SP.J.1008.2011.01193 |
| 投稿时间：2011-07-26修订日期：2011-09-15 |
| 基金项目: |
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| Clinical electrophysiological characteristics of atrial fibrillation originated from superior vena cava |
| SHI Xiang-min1,WANG Yu-tang1*,SHAN Zhao-liang2,YUAN Hong-tao2,YANG Ting-shu1 |
(1. Department of Cardiology (South Building), General Hospital of PLA, Beijing 100853, China;
2. Department of Cardiology, General Hospital of PLA, Beijing 100853, China
*Corresponding author.) |
| Abstract: |
| Objective To analyze the characteristics of surface electrocardiographic (ECG) and intracardiac electrophysiological mapping of atrial premature contractions (APC) and atrial fibrillation (AF) originated from the superior vena cava (SVC), so as to investigate the electrophysiological mechanism of AF with SVC origin. Methods The clinical data of 12 patients(mean age 55.3±12.2 years) with paroxysmal AF were retrospectively analyzed; the patients were electrophysiologically confirmed with AF of SVC origin and were hospitalized for radiofrequency ablation during Sept. 2006 to Aug. 2010. The P waves of APC from SVC in inferior leads and V1, morphology of AF, procedure time, ablation sites within SVC, complications and success rate were all analyzed. Results Compared with P wave of sinus rhythm (SR), the P amplitude of APC from SVC was significantly greater ( mV vs mV, P<0.05) in lead Ⅱ, and in lead V1 the ratio of biphasic morphology was significantly higher (91.6% vs 33.3%, P<0.05). The figures of fibrillation wave were similar to P waves of SR and APC in 8 patients (8/12,66.6%). Compared with the electrical isolation of left superior pulmonary vein (LSPV), SVC isolation needed a significantly shorter time ( min vs min, P<0.05)and a significantly less ablation site ( vs , P<0.05). Eight patients still presented persistent rapid firing within SVC after isolation; two patients suffered paroxysmal atrial flutter 1 month after procedure and were controlled by antiarrhythmia drugs. No patients had complications. Conclusion The APC and AF of SVC origin manifest specific ECG patterns, which helps to predict the target vena before ablation; the isolation of SVC needs a shorter time period and less ablation points, and with high success rate. |
| Key words: superior vena cava atrial fibrillation atrial premature contractions radiofrequency ablation electrophysiology |
