上腔静脉起源的阵发性心房颤动的发现及电隔离  

Atrial fibrillation originated from superior vena cava after pulmonary vein ablation

作　　者：张林忠[1] 陈明龙[1] 杨兵[1] 居维竹[1] 张凤祥[1] 陈红武[1] 顾凯[1] 郦明芳[1] 余金波[1] 李小荣[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,江苏南京210029

出　　处：《中国心脏起搏与心电生理杂志》2013年第3期204-206,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的报道经环肺静脉电隔离后发现上腔静脉触发灶的心房颤动(简称房颤)及电隔离。方法 2009年10月至2011年6月行肺静脉电隔离治疗的阵发性房颤患者451例,电隔离后另行上腔静脉电生理检查,明确有否上腔静脉起源的房颤。结果 27例有起源于上腔静脉的房颤(6%),其中22例为上腔静脉早搏触发房颤,5例为上腔静脉房性心动过速驱动心房快速激动。27例中7例为基础状态下发作房颤,其余为异丙肾上腺素和三磷酸腺苷或者电复律后诱发。均于上腔静脉与右房交界上方约1～2 cm处行上腔静脉电隔离。随访6～32个月,3例复发。结论上腔静脉起源的房颤在阵发性房颤中发生的比例为6%。上腔静脉电隔离后长期复发率较低。Objective To report the clinical experience of catheter ablation of atrial fibrillation （AF） originating from superior vena cava （SVC）. Methods Patients with documented SVC-originated AF from a pool of paroxysmal AF （451 cases） who underwent catheter ablation procedure during the past 2 years were enrolled, their clinical and electrophysiological characteristics were systematically analyzed. Results The AF in 27 patients （M/F= 12/15 cases, mean age of 52.3 ＋12.5 years old） were confirmed to be originated from SVC （6%）. The sustainable AF or atrial tachycardia were found to be triggered or driven by fast activations within SVC and were terminated by isolation of SVC, either with or without any inducing technique （isoproterenol, adenosine triphosphate and cardioversion during AF）. After a mean period of 15-month follow up, 3 patients recurred and one patient received repeat procedure. No complications were found. Conclusion To- tally 6% of paroxysmal AF are originated from SVC. Detailed dectrophysiological study including isoproterenol and bolus injection of adenosine-triphosphate may help to reveal the culprit sources.

关 键 词：电生理学 阵发性心房颤动 导管消融 射频电流 上腔静脉电隔离 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]