上腔静脉起源房性心律失常的电生理特征及导管消融治疗效果  

Electrophysiological characteristics and radiofrequency catheter ablation of atrial arrhythmias originating from superior vena cava

作　　者：韩魏[1] 王祖禄[1] 梁明[1] 杨桂棠[1] 金志清[1] 孙鸣宇[1] 韩雅玲[1] HAN Wei WANG Zu-lu LIANG Ming YANG Gui-tang JIN Zhi-qing SUN Ming-yu HAN Ya-ling(Department of Cardiology, General Hospital, Shenyang Military Area Command, Shenyang, Liaoning 110016, China)

机构地区：[1]沈阳军区总医院心内科,辽宁沈阳110016

出　　处：《心脏杂志》2017年第2期171-175,共5页Chinese Heart Journal

基　　金：辽宁省科学技术计划项目资助(2014305006);辽宁省自然科学基金项目资助(20102247)

摘　　要：目的探讨上腔静脉(SVC)起源房性心律失常的导管消融策略。方法经心内电生理检查和导管消融证实起源于SVC房性心律失常共14例,在传统或三维标测系统指引下,结合SVC造影确定最早激动点或起源部位,局灶性消融或节段性/环状消融电隔离SVC。结果 5例房性心动过速(AT)在SVC内标测到最早激动点,局灶性消融成功;9例SVC起源房性早搏(PAC)伴发心房颤动(AF)患者经节段性或环状消融电隔离SVC成功。3例术中SVC电隔离后出现SVC自律电活动。结论 SVC起源房性心律失常有特征性的心内电生理特点,消融时应注意识别AT或PAC。可通过局灶性或阶段性/环形电隔离SVC消融成功。AIM To investigate the strategy of radiofrequency catheter ablation （RFCA） of atrial arrhythmias originating from superior vena cava （SVC）. METHODS The study enrolled 14 patients undergoing electrophysiological examination and radiofrequency catheter ablation of atrial arrhythmias originating from SVC. The origin site with the earliest atrial activation was mapped under the guidance of traditional mapping technique or cardiac three-dimensional （3D） mapping system combined with SVC angiography. RFCA of the SVC origin was performed by focal, segmental or circular ablation. The electrophysiologic features and the strategies of RFCA in the 14 patients were analyzed. RESULTS RFCA eliminated atrial tachycardia （AT） in five patients by focal ablation and eliminated premature atrial contraction （PAC）, which might trigger atrial fibrillation （AF） by segmental and circular isolation of SVC, respectively, in six and three patients. After isolation of SVC, three patients had automatic electrical activity in SVC. CONCLUSION Atrial arrhythmias originating from SVC has some typical cardiac electrophysiological characteristics. RFCA could eliminate focal AT or PAC originating from SVC by focal ablation and segmental or circular isolation of SVC.

关 键 词：上腔静脉 心房颤动 心动过速 房性 射频导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]