紊乱性房性心动过速的机制探讨  

The Electrophysiological Mechanism Of Chaotic Atrial Tachycardia

作　　者：李晓枫[1] 侯煜[1] 刘俊[1] 方丕华[1] 张澍[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心律失常诊治中心,北京100037

出　　处：《中国医刊》2010年第1期47-50,共4页Chinese Journal of Medicine

摘　　要：目的观察紊乱性房性心动过速的临床及电生理表现,探讨紊乱性房速的电生理机制。方法 8例反复心悸患者,经体表12导联静态心电图或12导动态心电图诊断为紊乱性房性心动过速,行电生理标测准确定位房速的起源部位,进而行射频消融治疗。在窦性心律下应用三维标测系统先构建左房及肺静脉解剖图,之后在Remap模式下行激动标测,确定房性期前收缩(PACs)和(或)房速(AT)发作时首个心房搏动的最早激动起源位置。用盐水灌注导管先在最早激动处进行消融,若PACs或短暂AT消失则认定为有效。如果标测AT起源于肺静脉,若消融前伴频发PACs和短阵持续性AT,消融一侧肺静脉后均立刻消失,可较肯定确定其起源,则只进行单侧肺静脉消融;若术中自发PACs和短阵AT较少,考虑到存在起源于其他肺静脉的可能性,则行左右双侧肺静脉消融直至经Lasso电极证实达到完全电隔离。术后1周内复查动态心电图并随访至术后24个月。结果 8例患者术中都有自发性PACs及短暂非持续性AT。经标测确定最早激动点分别起源于RSPV 4例、RIPV 1例、LSPV 3例。8例患者局部消融后PACs和房性心动过速均消失。其中4例行单侧肺静脉消融达到完全电隔离;另4例行左右双侧肺静脉消融至完全电隔离。消融前后PACs数量分别为17815.3±10870.5和26.9±17.2;术前AT阵数为312.5±536.3,消融后无AT发作,并无任何其他心律失常发生。结论部分紊乱性房速的机制可能是位于肺静脉单个起搏点的自律性异常所致,由于异位激动的传导路径以及传导速度的不一致导致了P′波的多形性以及心房紊乱心律的发生。Objective To investigate the electrophysiological mechanism of chaotic atrial tachycardia （CAT） by mapping and radiofrequency catheter ablation of the arrhythmia. Methods Eight patients with CAT underwent a standard EPS, electro-anatomical mapping （EAM） and radiofrequency catheter ablation. LA and pulmonary veins （PVs） were first mapped and reconstructed with EAM in sinus rhythm, then activation mapping was performed under the mode of Remap to look for origin site of the PACs or CAT. As soon as the origin site was localized, the ablation followed. If the CAT originated from PVs, circumferential pulmonary vein ablation （CPVA） was performed. All patients received Hoher monitoring within a week post-ablation. Result The origin site of CAT was located at RSPV in 4 patients, RIPV in 1, LSPV in 3 respectively. The CAT disappeared and could not induced after the CPVA in all patients. Four patients just received CPVA in one-side relevant PV because definite origin site had been mapped out. Other 4 patients got all PVs ablated. The PACs in pre-ablation and post-abhion hoher were 17815.3 ±10870. 5 vs. 26.9 ± 17.2, the episode of AT in pre-ablation was 312.5± 536.3 and none in post-abhion. Conclusion CAT might be idiopathic in a part of patients and its mechanism may be abnormal automaticity of single focus located at PVs. The conducting pathway and conducting velocity of ectopic excitement varied beat to beat and resulted in the polymorphism of P wave and the presentation of chaotic atrial arrhythmias.

关 键 词：紊乱性房性心动过速 机制 三维电解剖标测 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]