心房颤动患者窦房结分布及上腔静脉肌袖的三维电解剖标测  

Three dimensional electroanatomic mapping of sinus node distribution and superior vena cava muscle sleeve in patients with atrial fibrillation

作　　者：陈信光 张凤祥 陈红武 居维竹 郦明芳 杨刚 刘海雷 王子盾 陈求实 陈明龙 Chen Xinguang;Zhang Fengxiang;Chen Hongwu;Ju Weizhu;Li Mingfang;Yang Gang;Liu Hailei;Wang Zidun;Chen Qiushi;Chen Minglong(Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)心血管内科,南京210029

出　　处：《中华心律失常学杂志》2022年第2期176-180,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：广东省钟南山医学基金会课题(ZNSA-2020017-3)。

摘　　要：目的通过三维电解剖标测系统观察心房颤动(房颤)患者上腔静脉肌袖结构,了解窦房结分布特点。方法选取2018年1月至2020年1月于南京医科大学第一附属医院心血管内科接受射频导管消融隔离上腔静脉的房颤患者80例,男49例,女31例,年龄(59.3±8.9)岁,年龄范围18~75岁。其中阵发性房颤55例,持续性房颤25例,窦性心律下标测上腔静脉及右心房的电激动顺序,标注窦房结位置。结果46例(46/80,57.5%)患者窦房结位于右心房-上腔静脉交界处以下,其中42例位于高位右心房(42/46,91.3%),4例位于中位右心房(4/46,8.7%),未发现窦房结位于低位右心房。窦房结与右心房-上腔静脉交界处的距离为(9.4±6.1)mm。34例(34/80,42.5%)患者窦房结位于右心房-上腔静脉交界处以上,其中17例位于上腔静脉侧壁(17/34,50.0%),8例位于前壁(8/34,23.5%),5例位于间隔侧(5/34,14.7%),4例位于后壁(4/34,11.8%),窦房结与右心房-上腔静脉交界处的距离为(8.5±5.1)mm。阵发性和持续性房颤患者在窦房结的空间分布上差异无统计学意义(P=0.247)。上腔静脉肌袖长度为(36.5±9.0)mm,其中阵发性与持续性房颤患者肌袖长度分别为(36.2±8.6)mm与(37.3±10.0)mm,两组差异无统计学意义(P=0.622)。结论对于大多数房颤患者,窦房结主要位于右心房-上腔静脉交界处下方,但有一些患者窦房结位于右心房-上腔静脉交界处上方即上腔静脉内,上腔静脉隔离消融线的设定应注意到窦房结位置,避免损伤窦房结。Objective To delineate the locations of sinus node(SN)and decrible the myocardial sleeve structure of superior vena cava(SVC)using three dimensional electroanatomic(3D)mapping system.Methods Eighty atrial fibrillation(AF)patients(paroxysmal AF 55,persistent AF 25)who received SVC isolation(SVCI)underwent 3D activation mapping in sinus rhythm in Department of Cardiology,the First Affiliated Hospital with Nanjing Medical University form January 2018 to January 2020.There were forty-nine males and thirty-one females,with an average age of(59.3±8.9)years.The location of sinus node was noted.Results Forty-six AF cases(46/80,57.5%)showed SN located below the right atrial(RA)-SVC junction,of which 42(42/46,91.3%)were located in high RA and 4(4/46,8.7%)in middle RA with the average(9.4±6.1)mm distance between SN and RA-SVC junction.The SN was located above the RA-SVC junction in 34 AF cases(34/80,42.5%),including 17(17/34,50.0%)in the lateral wall,8(8/34,23.5%)in the anterior wall,5(5/34,14.7%)in the septal aspect and 4(4/34,11.8%)in the posterior wall.The mean distance between the SN and the RA-SVC junction was(8.5±5.1)mm.There was no significant difference in the spatial distribution of SN between paroxysmal and persistent AF(P=0.247).The average length of myocardial sleeve was(36.5±9.0)mm,in patients with paroxysmal and in persistent AF that was(36.2±8.6)mm and(37.3±10.0)mm.There was no significant difference between the two groups(P=0.622).Conclusion For most patients with AF,the SN is mainly located below the RA-SVC junction,but there are still a large number of patients whose SN is located above the RA-SVC junction,namely in the SVC.During SVCI,the ablation line design should pay attention to this situation to avoid damage to the SN.

关 键 词：心房颤动 窦房结 上腔静脉 肌袖 

分 类 号：R541.75[医药卫生—心血管疾病]