起源于心房下部局灶性房性心动过速电生理特点及射频消融治疗  

Electrophysiologic characteristics and radiofrequency ablation for focal atrial tachycardias originating from inferior right atria

作　　者：李树岩[1] 崔燕[1] 刑月[1] 李淑梅[1] 

机构地区：[1]吉林大学第二医院心内科,长春130041

出　　处：《临床心血管病杂志》2006年第6期331-333,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨起源于右房下部局灶性房性心动过速(AT)电生理特点及射频消融的疗效。方法:对3例起源于下腔静脉口及1例起源于冠状静脉窦口AT病例分析其心电图特点,行常规心内电生理检查,明确AT时心房激动顺序,寻找心房激动最早起源点标测与消融,临床随诊评价疗效。结果:3例下腔静脉口部AT患者心电图Ⅱ、Ⅲ、aVF、V1导联P'为负,I、aVL为正;1例冠状窦口部AT患者心电图Ⅱ、Ⅲ、aVF及V1导联P'波为负、正双向,Ⅰa、VL P'低平,不易区别。成功消融靶点双极电图A-P间期(40±15)ms,单极电图心房或冠状窦口部起源的AT心电图有一定特征,可大致区分AT起源部位。结论:单极电图与双极电图对AT的消融有较高的特异性,射频消融是治疗起源于心房下部局灶性AT的首选方法。Objective：To report 4 patients with focal atrial tachycardias（AT）originating from inferior vena cava （3 cases）and coronary sinus（1 case） and evaluate the electrophysiologieal characteristics and radiofrequency ablation efficacy. Method：Routine electrophysiological study were performed in 4 patients with focal AT. The site of origin of focal AT were mapped and ablated . Follow-up study evaluated the efficacy of ablation. Result： The P waves of focal AT originating from inferior vena cava had negative polarity in lead Ⅱ , Ⅲ ,aVF,and V1 , and positive in lead Ⅰ ,aVL. That originating from coronary sinus had both negative and positive polarities in lead Ⅱ , Ⅲ, aVF and V1 ,the amplitude of P waves were lower and their polarity could not be confirmed in lead Ⅰ ,aVL. A P intervals of successful ablation sites in bipolar electrogram were （40 ± 15）ms. Unipolar electrogram displayed a completely negative atrial wave （＂QS＂morphology） beginning with intrinsic deflection. Conclusion：Polarity of P wave during atrial tachycardia can be used to measure identifily in target indentification of successful ablation of focal AT specially.

关 键 词：房性心动过速 导管消融术 心图描记术 腔静脉 下 冠状静脉窦 

分 类 号：R541.71[医药卫生—心血管疾病]