风湿性心脏病心房颤动起源的心脏电生理研究  

Valvular Atrial Fibrillation: Electrophysiological study and etopic origin

作　　者：刘浩[1] 郭继鸿[1] 

机构地区：[1]北京大学人民医院电生理室

出　　处：《中国介入心脏病学杂志》2005年第4期222-224,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的标测风湿性心脏病合并心房颤动(房颤)的患者房颤的起源部位,探讨房颤起源部位的电生理特点,观察肺静脉起源的房颤所占的比例。方法选择9例风湿性心脏病二尖瓣狭窄伴阵发性或持续性房颤、拟行经皮球囊二尖瓣扩张术的患者。其中6例为持续性房颤,3例为阵发性房颤;男1例,女8例;年龄(42±13)岁。6例持续性房颤患者术前2～3周予抗凝治疗,术前7天予胺碘酮药物转复,1例转复成功,另5例经同步直流电转复治疗成功。二尖瓣球囊扩张术后行电生理检查:四极电极导管分别置入冠状静脉窦、高位右心房,大头电极导管或Lasso电极导管置于左心房、肺静脉。分别于右心房、左心房、冠状静脉窦、各个肺静脉行S1S2及S1S2S3程序刺激,诱发房颤。上述方法不能诱发房颤时,行相应部位的猝发(burst)刺激。结果9例患者可诱发出12个房颤的起源点,源于右心房者4个,左心房1个,冠状静脉窦2个,肺静脉5个。肺静脉5个起源中,左上肺静脉、左下肺静脉、右上肺静脉分别为3例、1例、1例。结论风湿性瓣膜病的房颤存在肺静脉起源。Objective Mapping the sites of earliest activation in AF patients with rheumatic heart disease. Finding out the ratio of AF originate from the pulmonary veins. Methods There were 9 patients with valvular atrial fibrillation （1 male, 8 females age （42± 13） years, histories of rheumatic heart disease （11 ±9） years, and mitral valve area 1.01 ± 0.02 cm^2 ） involved in the research. 3 patients had organized thrombus in left atrial appendage. 6 patients with persistent AF received antieoagulation therapy （warfarin 2 or 3 weeks） and drug eardioversion （amiodarone 400 mg, three times per day, for 7 days） before procedures, while other 3 patients with paroxysmal AF received neither antieoagulation therapy nor drug eardioversion. All patients received pereutaneous balloon mitral valvotomy （PBMV）. After finished PBMV, four multipolar electrode catheters were placed in the high right atrium （HRA）, coronary sinus （CS）, left atrium （LA） and pulmonary veins （PVs）. S1S2 and S1S2S3 programmed stimuli were delivered in HRA, CS, LA and PVs respectively. For the patients who failed to induce AF, burst stimuli were used. Results 11 AF generating sites, which induced by S1S2 and S1S2S3 programmed stimuli, could be confirmed by identification of the earliest regions of atrial activation for the first AF cycle. However, 1 AF obtained by 260 ms RR interval burst stimuli, affirmed by shortest activation cycle length. All confirmed 12 AF original sites were original as following： RA （ n = 4）, LA （ n = 1 ）, CS （ n = 2） ; PVs （ n = 5）. Among the 5 PVs original sites, 3 was from left superior ptthnonary vein, while the other 2 were from right superior pulmonary vein and left inferior pulmonary respectively. Conclusion PVs could be the ectopic origin of valvular AF.

关 键 词：风湿性心脏病 心房颤动 肺静脉 心脏电生理学技术 风湿性心脏病二尖瓣狭窄 电生理研究 经皮球囊二尖瓣扩张术 肺静脉起源 持续性房颤 冠状静脉窦 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]