二尖瓣环间隔起源局灶性房性心动过速电生理特征与射频消融  

Electrophysiological characteristics of mitral annular septum originated focal atrial tachycardia and therapy of radiofrequency ablation for it

作　　者：王云龙[1] 梁卓[1] 王芸[1] 韩智红[1] 汪烨[1] 任学军[1] 李学斌[2] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]北京大学人民医院心内科,北京100044

出　　处：《中国循证心血管医学杂志》2016年第12期1470-1473,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨二尖瓣环间隔起源局灶性房性心动过速（房速）心电图（ECG）特性,电生理特性和射频消融治疗（RFA）。方法 13例患者经心内电生理检查证实起源于二尖瓣环间隔侧房速（简称二尖瓣间隔房速）,其中男性6例,女性7例,年龄23-47（35±12）岁,心动过速病史1-6年。结果 12例患者经穿房间隔途径标测消融成功,1例经主动脉逆行途径标测消融成功。根据局部电位特征,X线影像和三维标测系统确定成功消融位点分别为：二尖瓣环前间隔旁8例,二尖瓣环中间隔到前间隔之间3例,二尖瓣环后间隔2例。所有房速心电图V1导P波均表现出负正双向,右房激动标测显示最早右房激动点位于间隔侧（希氏束区域或冠状窦近端）。13例患者成功靶点局部电位均为小A大V,9例局部电位A波为复杂或碎裂的。所有患者均无明显并发症,12例长期随访无心动过速复发。结论二尖瓣环间隔区域是重要的房速起源点,常见于前间隔旁,其有独特P波形态和心内激活顺序。经穿间隔或逆行主动脉途径消融二尖瓣环间隔房速,安全有效。Objective To investigate the characteristics of electrocardiogram（ECG） and electrophysiology of mitral annular septum originated focal atrial tachycardia（AT） and therapy of radiofrequency ablation（RFA） for it. Methods The patients with confirmed mitral annular septum originated focal atrial tachycardia（mitral AT） were diagnosed by intracardiac electrophysiological examination（n=13, male 6, female 7, aged from 23 to 47 and average age=35±12） and their medical history was from 1 to 6 y. Results The transseptal mapping and RFA were success in 12 cases and transaortic retrograde mapping and RFA were success in 1 case. According to local potential features, the RFA sites confirmed by X-ray photograph and 3-D mapping system and given RFA successfully were as follows： beside of anterior mitral annular septum（in 8 cases）, between medium and anterior mitral annular septum（in 3 cases） and beside of posterior mitral annular septum（in 2 cases）. P wave in lead V1 of ECG in all patients showed both negative and positive phases. The right atrial electric activation mapping showed that the right atrial earliest activation site was located in side of mitral annular septum（His bundle zone or proximal coronary sinus）. The local potential in successful target spots all showed micro-A-wave and macro-V-wave in 13 cases, and local potential of A-wave was complicated or cataclastic in 9 cases. All patients had no significant complications, and 12 cases had no re-attack of mitral AT after a long-term follow-up. Conclusion The zones surrounding mitral annular septum are important originating sites of mitral AT, and a common one beside anterior mitral annular septum with special P wave and sequence of intracardiac activation. The transseptal RFA or transaortic retrograde RFA are safe and effective during treatment of mitral AT.

关 键 词：房性心动过速 二尖瓣环间隔 三维标测 电激动标测 消融 

分 类 号：R541.71[医药卫生—心血管疾病]