起源于冠状静脉窦口附近的局灶性房性心动过速心电图P波形态分析和射频导管消融疗效观察  

Analysis of Electrocardiographic P Morphology and Efficacy of Radiofrequency Ablation of Focal Atrial Tachycardia from the Ostium of Coronary Sinus

作　　者：徐韶君 蒋峻[1] 张昱[1] 马骥[1] 

机构地区：[1]浙江大学医学院附属第二医院心血管内科,310009 [2]浙江省兰溪市人民医院心内科

出　　处：《心电与循环》2012年第6期421-423,I0001,共4页Journal of Electrocardiology and Circulation

摘　　要：目的评价起源于冠状静脉窦口附近的房性心动过速的心电图房性P波形态特征,观察此类型心律失常射频导管消融（下称消融）治疗效果.方法通过三维电解剖标测系统（Carto XP）精确定位9例起源于冠状静脉窦口附近的房性心动过速,并回顾性分析其体表心电图房性P波的形态特征,探讨二者之间的联系;并研究此类型房性心动过速消融治疗的效果.结果9例房性心动过速均在冠状静脉窦口附近获得精确定位并成功消融,同时对其体表心电图的分析发现,本组房性心动过速体表心电图中P波特征如下：Ⅱ、Ⅲ、aVF P波呈负向波;ⅠP波低平,呈等电位线或低幅的正向波;aVL多呈正向波,多数病例V1 P波前半部分为等电位线,后半部分为正向波,胸导联P波在V3~V5逐渐移行为负向.9例房性心动过速患者均接受三维指导下消融治疗,成功转复为窦性心律,长期随访无复发.结论冠状静脉窦口附近是右心房房性心动过速的重要起源部位之一,其体表心电图P波有较明确的形态特征.三维电解剖标测系统可以快速对此类型房性心动过速作出精确定位,并进一步缩短放射透视及消融时间.同时具有较高的治疗成功率和长期维持率.Objective To analyze electrocardiographic P characteristics and the efficacy of radiofrequency ablation of focal atrial tachycardia（AT） originating from the ostium of coronary sinus（CS）. Methods Atrial P morphology on electro- cardiogram and the efficacy of ablation were analyzed retrospectively in 9 patients with focal AT from the ostium of CS po- sitioned by CARTO system. Results The original sites around CS ostium were localized accurately and ablated suc- cessfully without recurrence of AT in a long term follow-up in all 9 patients. Electrocardiogram analysis showed that the P wave of AT was inverted in lead II, III and aVF, isoelectric or low amplitude and positive in lead I, and mostly positive in lead aVL. The first half of P wave was isoelectric and the last half was positive in lead V1 in most cases. P wave changed from positive to negative gradually from lead V3 to lead V5. Conclusions AT from CS ostium has a specific P morphology. CARTO system contributes to rapid and accurate location of focal AT and a high ablation success rate.

关 键 词：心电图 房性心动过速 冠状静脉窦口 射频导管消融 三维标测系统 

分 类 号：R541.7[医药卫生—心血管疾病]