三维电解剖标测重建窦房结最早激动的临床研究  

Re-modeling of the earliest activation of sinoatrial node by using Carto3 electroanatomical mapping system

作　　者：齐书英[1] 李洁[1] 胡振彦[1] 李斌[1] 王晓晔[1] 许娜[1] 栾雪冰[1] 席爱雪[1] 王冬梅[1] 

机构地区：[1]中国人民解放军白求恩国际和平医院心血管内科,石家庄050082

出　　处：《中国循证心血管医学杂志》2015年第6期787-788,共2页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 以三维电解剖标测系统（Carto3）标测经股静脉途径行导管消融的心脏结构正常的患者的窦房结最早激动点。方法 选择2014年7月至2015年4月在白求恩国际和平医院心血管内科经股静脉途径行导管消融的74例心律失常患者,由同一术者完成手术。手术在Carto3指导下完成消融后,以FAM方式重建上腔静脉和部分右心房,在窦性心律下以高密度激动标测寻找窦房结最早激动点。结果 74例患者经检查排除器质性心脏病,窦房结最早激动点至上腔静脉的距离（纬度）为27.05±7.54mm（16-52mm,中位数26.85 mm）,其中距离为20-35 mm者54例（占72.97%）。在LAO45°＋SUP体位标测窦房结（经度）中位数位于9点钟（5-12点钟）,其中9点钟30例（占40.54%）。结论 三维电解剖标测窦房结最早激动点快速、便捷;窦房结位置变异可以部分解释正常窦性心律的P波形态不单一;导管射频消融治疗右房上部心律失常时需先标测窦房结位置,避免发生窦房结损伤并发症。Objective To map the earliest activation of sinoatrial node by using Carto3 electroanatomical mapping system（Carto3） in patients with normal cardiac structure undergone radiofrequency ablation（RFA） via femoral vein. Methods The patients with arrhythmia（n=74） undergone RFA via femoral vein by a same surgeon were chosen from Jul. 2014 to Apr. 2015. After RFA finished under Carto3 guide, FAM mode was used for remodeling superior vena cava and partial right atrium. The earliest activation of sinoatrial node was searched by high-density activation mapping under sinus rhythm. Results Organic heart diseases were excluded in 74 patients. The distance from the earliest activation of sinoatrial node to superior vena cava（latitude） was 27.05 mm±7.54 mm（16 mm-52 mm, median=26.85 mm）, and in 54 patients, the distance was 20 mm-35 mm（72.97%）. The median of sinoatrial node（latitude） mapped at LAO45°＋SUP position was at 9 o＇clock（5-12 o＇clock）, and in 30 patients（40.54%）, the median was 9 o＇clock. Conclusion Carto3 is fast and easy for mapping the earliest activation of sinoatrial node. The variation of sinoatrial node position can partly explain the inconformity of P wave of normal sinus rhythm. The position of sinoatrial node should be mapped at first during RFA in treatment of arrhythmia originated from upper right atrium for avoiding the complications of sinoatrial node injury.

关 键 词：窦房结 右心房 三维 标测 上腔静脉 心律失常 

分 类 号：R322.11[医药卫生—人体解剖和组织胚胎学]