起源于左心耳局灶性房性心动过速的电生理特征和射频消融治疗  

Electrophysiological characterization and efficacy of radiofrequency ablation of focal atrial tachycardia originating from the left atrial appendage

作　　者：王云龙[1] 郭继鸿[2] 李学斌[2] 任学军[1] 韩智红[1] 陈方[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029 [2]北京大学人民医院心内科

出　　处：《中华心血管病杂志》2010年第6期493-496,共4页Chinese Journal of Cardiology

摘　　要：目的 报道一组起源于左心耳局灶性房性心动过速（房速）的电生理特征和射频消融治疗.方法 9例患者中男性5例,平均年龄（21±9）岁,经心内电生理检查和射频消融证实为起源于左心耳的房速,对其电生理特点及射频消融进行分析.结果 左心耳房速表现为无休止性或静脉滴注异丙肾上腺素诱发,程序刺激不能诱发或终止房速.左心耳房速有独特的体表心电图特征,所有患者P波Ⅰ、aVL导为负向,Ⅱ、Ⅲ、aVF导联P波高而直立.V1导P波为直立或正负双向（以直立为主）,V2～V6导P波为等电位线（5例）或〈0.1 mV低幅直立（4例）.常规心内标测,最早心房激动为CS远端.成功靶点处局部心房激动领先P波起始（36.7±7.9）ms.5例患者最终使用盐水灌注导管消融成功,随访（12 ±5）个月无房速复发.结论 左心耳房速有独特的心电图特征和房内激动顺序,对这类房速盐水灌注导管可能是更好的选择,左心耳内局灶消融长期随访安全有效.Objective To analyze the electrophysiological characteristics and efficacy of radiofrequeney catheter ablation （ RFA ） of focal atrial tachycardia （AT） originating from the left atrial appendage （LAA）. Methods Electrophysiologic study and RFA were performed in 9 patients （4 female）with focal AT originating from the LAA. Atrial appendage angiography was performed to identify the origin of AT. P waves were classified as negative, positive, isoelectric, or biphasic. Results The mean age was （21 ±9）years. AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing. A characteristic P-wave morphology and endocardial activation pattern were observed. Positive P-wave in inferior leads was seen in all patients, upright or biphasic （ ＋/- ）component P wave was observed in lead V1, isoelectric component or an uptight component P wave with low amplitude （ 〈 0 1 mV） was seen in lead V2 - V6. Earliest endocardial activity occurred at the distal coronary sinus （CS） in all patients. The earliest endocardial activation at the successful RFA site occurred （36. 7 ± 7.9 ） ms before the onset of P wave. RFA was successful in all 9 patients immediately post procedure. AT reoccurred in 2 patients within 1 month post RFA and AT disappeared post the 2nd-RFA. AT reoccurred in 1 patient and terminated after the 3rd RFA. At the final follow-up （ 12 ± 5 ） months, all 9 patients were free of arrhythmias without antiarrhythmic drugs. Conclusions The LAA is an uncommon site of origin for focal AT. The characteristic P wave and activation timing are suggestive for focal AT originating from the LAA. LAA focal ablation is safe and effective for patients with focal AT originating from the LAA.

关 键 词：心动过速 异位房性 心耳 导管消融术 电生理学 

分 类 号：R541.7[医药卫生—心血管疾病]