主动脉窦不同部位房性心律失常心电图与电生理特征比较  

Electrocardiogram and electrophysiological characteristics of atrial arrhythmia originated from different parts of aortic sinus

作　　者：邵佳梦 俞佳圣 郑程[1] 沈冰 李晓伟[1] 林佳选[1] 林加锋[1] SHAO Jiameng;YU Jiasheng;ZHENG Cheng;SHEN Bing;LI Xiaowei;LIN Jiaxuan;LIN Jiafeng(Department of Cardiology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院心内科,325000

出　　处：《心电与循环》2025年第1期56-61,共6页Journal of Electrocardiology and Circulation

基　　金：国家自然科学基金项目(82070333);温州市科研项目(ZY2020018、Y20220472)。

摘　　要：目的比较主动脉窦(AS)不同部位房性期前收缩(PAC)与房性心动过速(AT)心电图及电生理特征差异。方法回顾性选取2018年6月至2023年6月在温州医科大学附属第二医院接受消融且经三维标测最终在AS处消融成功的18例PAC和AT患者为研究对象,根据有效靶点X线检查及三维标测定位结果分为左冠窦(LCC)组3例和无冠窦(NCC)组15例;比较两组患者心电图形态及电生理特征差异。结果LCC组心电图P'波在Ⅱ、Ⅲ、a VF为正向或等电位线,在Ⅰ为负向或等电位线,在V1为正向。NCC组心电图P'波在Ⅱ、Ⅲ、a VF为正负双向或等电位线,在Ⅰ为正向或等电位线;在V1为正负双向或负向。在电生理标测中,两组患者均在右心房房间隔处标测到最早A波,但可标测到最早A波范围有所差异。两组患者最大的电生理特征差异是左心房内标测到最早A波具体位置不同,其中LCC组位于左心房前壁邻近左心耳基底部且与LCC毗邻,NCC组位于左心房前壁与房间隔交接处且与NCC毗邻。结论起源于NCC的PAC/AT较为常见,而LCC不多见,两者心电图及电生理特征不同,识别这些特征有助于进一步提高消融成功率。Objective To investigate differences in electrocardiogram(ECG)and electrophysiological characteristics of premature atrial contraction(PAC)and atrial tachycardia(AT),originated from different parts of the aortic sinus(AS).Methods From June 2018 to June 2023,a total of 18 patients who received catheter ablation for PAC/AT and were successfully ablated at AS after systematic mapping in the Second Affiliated Hospital of Wenzhou Medical University were enrolled.According to both fluoroscopy and three-dimensional mapping,the atrial arrhythmia patients were divided into two groups:left coronary sinus(LCC)group(n=3)and non-coronary sinus(NCC)group(n=15).Characteristics of ECG and electrophysiological were analyzed and compared.Results The ECG characteristics of NCC group were as follows:P'waves were biphasic(positive-negative)or isoelectric in leadsⅡ,Ⅲ,and aVF,positive or isoelectric in leadⅠ,and biphasic(positive-negative)or negative in lead V1.ECG characteristics of LCC group were as follows:P waves were positive or isoelectric in leadsⅡ,Ⅲand aVF,negative or isoelectric in leadⅠ,and positive in lead V1.Regular activation mapping in right atrium showed that a relative earlier atrial activation was located at atrial septum in both groups,but the size of the range was different.The most significant difference in electrophysiological characteristics between the two groups was the location of the earliest activation site measured in the left atrium:LCC group was located in the anterior wall of the left atrium adjacent to the base of the left atrial appendage and adjacent to the LCC,while the NCC group was located at the junction between the anterior wall of the left atrium and the atrial septum and adjacent to the NCC.Conclusion PAC/AT originated from NCC is more common,while that originated from LCC is rare.Their ECG and electrophysiological characteristics are different.Identification of these characteristics is helpful to improve the success rate of ablation.

关 键 词：房性心律失常 主动脉窦 心电图 电生理 射频导管消融 

分 类 号：R54[医药卫生—心血管疾病]