冠状静脉窦VI起搏对心房激动时间影响及方法学探讨  

Methodology and clinical effect on atrial activation of coronary sinus ostium pacing

作　　者：徐伟[1] 李晓宏[1] 吉文庆[1] 余洪松[1] 马冬辉[1] 狄文成[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心脏科,210008

出　　处：《中华心律失常学杂志》2007年第5期342-345,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察冠状静脉窦口起搏对心房激动时间的影响，并探讨该部位起搏的方法学。方法包括两部分，首先对20例射频消融的患者行心内电生理检查，术中分别给予高位右心房（HRA）、冠状静脉窦口（CS9-10）、左心房游离壁（CS1-2）起搏，记录刺激信号至腔内电图最远A波为心房激动时间；HRA至CS1-2的AA间期作为左、右心房间激动时间差，同时测量体表心电图最长P波时限。第二部分研究在可控弯导丝系统的辅助下将心房主动电极导线固定在冠状静脉窦口，比较冠状静脉窦口起搏与HRA起搏的起搏参数及起搏后体表心电图P波时限。结果冠状静脉窦口起搏时P波时限、心房激动时间及左、右心房激动时间差较窦性心律下、高位右心房及左心房游离壁起搏时均明显缩短。两组患者术中及术后起搏参数差异无统计学意义，冠状静脉窦口起搏患者体表心电图P波宽度明显缩短。结论冠状静脉窦口起搏时心房激动时间明显缩短，左、右心房间激动时间差最短。采用可控弯导丝系统的辅助可实现冠状静脉窦口起搏。Objective To investigate the effect of coronary sinus ostium （CSos） pacing on the duration of atrial activation, and the methodology of coronary sinus ostium pacing. Methods Twenty patients underwent a intracardiac electrophysiological study. The duration of atrial activation, inter-atrial activation time difference, and P wave duration maximum were recorded during pacing at the high right atrium, proximal coronary sinus （CS9-10） and distal coronary sinus（CS1-2）, The atrial activation, inter-atrial activation time difference and P wave duration were the shortest in CS9-10 pacing group, The difference in pacing parameters and atrial activation during atrial pacing was compared between HRA group and CSos group. Results CSos pacing markedly shortened the duration of atrial activation, inter-atrial activation time difference. There was no difference in the pacing parameter. The atrial activation of CSos pacing was notably shorter than HRA pacing. Conclusion CSos pacing markedly shortens atrial activation time and biatrial conduct time. The deflect-able stylet system enable credible atrial active lead positioning and CSos pacing.

关 键 词：心房激动时间 冠状静脉窦口起搏 

分 类 号：R541[医药卫生—心血管疾病]