起源于上腔静脉的房性快速心律失常的电生理特点和消融治疗  

Electrophysiologic characteristics and radiofrequency ablation for atrial tachyarrhythmias originating from the superior vena eava

作　　者：江洪[1] 黄从新[1] 唐其柱[1] 杨波[1] 王小红[1] 刘华芬[1] 

机构地区：[1]武汉大学人民医院心内科,430060

出　　处：《中华心律失常学杂志》2003年第3期133-138,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 报道4例起源于上腔静脉的房性心律失常的电生理特点和消融治疗。方法分析4例病人房性心律失常的心电图特点,标测上腔静脉和心房确定房性心律失常的激动起源,局灶点消融上腔静脉内异常电活动最早起源点或消融电隔离上腔静脉-右心房连接以终止心律失常,临床随访评估疗效。结果 4例病人均有频发房性早搏和短阵房性心动过速,1例病人有短阵心房颤动。心律失常的异常P波在Ⅰ、Ⅱ、Ⅲ、aVF和V_1导联直立,aVR导联倒置。房性心律失常的最早起源位于上腔静脉内,距其口部0.4～4.0cm。局灶消融和电隔离消融分别有效终止房性心动过速(2例)和完全电隔离上腔静脉-右心房传导(2例)。随访4～14个月无临床症状发作。结论 起源于上腔静脉的房性心律失常有特殊的心电图表现,射频消融治疗有良好的临床效果。Objectives This paper reported 4 patients with atrial tachyarrhythmias originating from the superior vena cava and evaluated the electrophysiologic characteristics and radiofrequency ablation efficacy. Methods Sur-face and Holter electrogram were recorded and the features of arrhvthmias were analyzed. Multiple-site mapping of atria and superior vena cava was used to identify the origin of atrial tachvarrhvthmias. At the site of the earliest activations focal ablation (2 cases)was performed, and isolative ablation (2 cases)was used at the atriocaval junction to eliminate the tachyarrhythmias. Clinical follow-up evaluated the efficacy of ablation. Results Four patients had frequent pre-mature atrial contractions (PAG)and nonsustained atrial tachycardia (AT), and only one patient had nonsustained atrial fibrillation (AF). The P waves of tachyarrhythmia had positive polarity in lead Ⅰ、 Ⅱ 、 Ⅲ、 aVF and V1 , and negative in lead aVR. The earliest site of activation during tachyarrhythmia was located 0.4-4.0 cm above the atriocaval junction. Focal ablation of the superior vena cava potential eliminated the AT (2 cases)and the atriocaval isolation created exit block and prevented the atrial tachyarrhythmias. All 4 patients were free of the atrial arrhythmia during follow-up. Conclusion It is concluded that atrial tachyarrhythmias originating from the superior vena cava have characteristics on electrogram and radiofrequency ablation has clinical efficacy on controlling these arrhvthmias.

关 键 词：房性快速心律失常 上腔静脉 电生理特点 射频消融 治疗 

分 类 号：R541.7[医药卫生—心血管疾病]