射频消融局灶性房性心动过速患者的解剖分布及长期随访  

Catheter ablation of focal atrial tachycardia： the topographic distribution and long-term outcome

作　　者：夏野[1] 居维竹[1] 陈明龙[1] 杨兵[1] 张凤祥[1] 陈红武[1] 孙育民[1] 侯小峰[1] 陈椿[1] 邹建刚[1] 单其俊[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院江苏省人民医院心内科,210029

出　　处：《中华心血管病杂志》2012年第3期231-236,共6页Chinese Journal of Cardiology

摘　　要：目的报道局灶性房性心动过速（房速）的分布规律及长期随访结果。方法回顾性分析207例因房速作电生理检查的患者资料。结果207例患者中，185例明确为局灶性房速，共确定起源病灶200处。冠状窦口部的房速发生率最高，为23．8％，其次是界嵴20．5％，房室结周围20．0％，腔静脉17．8％，瓣环13．0％，心耳10．3％等。起源于右心房的局灶性房速占80．0％，起源于左心房的房速占17．8％。男性分布于左心房的房速比例显著高于女性（25．0％与13．3％，P=0．042），而右心房分布比例低于女性（69．4％与86．7％，P=0．004）。185例局灶性房速中，有173例（93．5％）获得即刻成功。常规标测组即刻成功率比三维标测组低，分别为79．3％（96／121）、96．5％（82／85），P〈0．01。经36个月的随访，共20例复发，远期成功率88．4％（153／173）。常规标测组与三维标测组之间差异无统计学意义（P〉0．05）。结论局灶性房速的起源部位具有丛集分布的特点，并且在左右心房之间有性别差异。常起源于冠状窦口、界嵴、房室结周围、腔静脉等心房内特殊解剖位置。射频消融即刻及远期成功率较高，并发症发生率极低，在有经验的电生理中心可以成为一线治疗选择。Objective To explore the topographic distribution and long-term outcome of catheter ablation for focal atrial tachycardia （AT）. Method The data of 207 patients who underwent electrophysiologic study for AT were retrospectively analyzed. Results A total of 200 AT were identified in 185 patients. The most common site for AT was ostium of the coronary sinus （23.8%） , followed by crista terminalis （20. 5% ） , perinodal area （20. 0% ） , eava vena （ 17.8% ） , annulus （ 13.0% ） , and appendage （ 10. 3% ）. Eighty percent AT originated from the right atrium, 17.8% originated from the left atrium. AT originated from the left atrium was more common in male than in female （25.0% vs. 13.3% ,P =0. 042） , while AT originated from the right atrium was more common in female than in male （69.4% vs. 86. 7% , P = 0. 004）. Among the 185 patients, acute success ablation rate was 93.5% （n = 173 ）. The acute success rate in the conventional mapping group was lower than that in the three-dimensional mapping group （79. 3% vs. 96. 5% , P 〈 0. 01 ）. During a median of 36 months follow up, the AT recurred in 20 patients （success ablation rate 88.4% ）. Success ablation rate was similar between the conventional mapping group and the three-dimensional mapping group （ P 〉 0. 05 ）. Conclusions Focal AT commonly originates from ostium of coronary sinus, crystal terminalis, periuodal area, and cava veins. There is a gender related difference in the distribution of focal AT. The radiofrequency catheter ablation yields a satisfying success rate and very low complication rate and could be the first line choice for treating ATs in experienced electrophysiological center.

关 键 词：心动过速 异位房性 电生理学技术 心脏 导管消融术 随访研究 

分 类 号：R541.7[医药卫生—心血管疾病]