阵发性心房颤动患者上腔静脉肌袖与心房的电学连接特征

总结 16例阵发性心房颤动患者上腔静脉 (SVC)肌袖的电生理标测和导管射频消融电隔离的结果 ,评价SVC肌袖和心房电连接的类型和特点。在环状标测电极指导下 ,对 16根SVC肌袖进行电位的记录、分析以及开口部的点或段的消融电隔离治疗。根据窦性心律和心房起搏下的肌袖内环形电极标测的袖电位激动顺序 ,即电突破点的数目和位置 ,以及有效放电对袖电位及其电突破点的影响 ,总结和分析袖房之间的电连接类型和特点。结果 :共标测和电隔离SVC肌袖 16根。其中呈单束状电连接 8根 (5 0 % ) ,双束状电连接 7根 (43.7% ) ,多束状电连接 1根 (6 .3% )。 16根SVC平均每根电连接束为 1.6± 0 .6根 ,共消融 2 .1± 0 .6个节段和部位 ,每个部位进行了2 .3± 0 .7次的放电。所有病例均达到完全电隔离的标准。结论 :SVC袖房之间电连接的类型多为单束状和双束状 ,在袖房连接处行点或节段性消融即可达到完全袖房电隔离的结果。

Characteristics of Electrical Connection Between the Right Atrium and Cardiac Muscle Sleeves of Superior Vena Cava in Patients With Paroxysmal Atrial Fibrillation

To investigated the electrophysiological characteristics of the junction of the right atrium (RA) and thesuperior vena cava (SVC) by summarizing the mapping and ostial ablation data of SVC in patients with paroxysmal atrial fibrillation (PAF),16 patients referred for electrical isolation of cardiac muscle sleeves by radiofrequency ablation to control drug-resistant PAF were enrolled. Guided by circular mapping catheter, the activation sequence of muscle sleeve potential during sinus rhythm and atrial pacing and its response to effective radiofrequency current delivery were analyzed. Results: 16 SVC were mapped and electrically isolated. Unibundle connections were found in 8 veins (50%), bi-bundle connections in 7 (43.7%), and multi-bundle connections in 1(7.3%). The number of breakthroughs was 1.6±0.6 per vein. Radiofrequency energy was applied with the end point of electrical disconnection .All breakthroughs were eliminated with 2.3±0.7 applications per breakthrough without complications. Conclusion:The electrical connection between SVC and right atrium can be unibundle, bi-bundle and multi-bundle, and the electrical isolation can be achieved by the focal ablation guided by the breakthroughs, which suggests that circumferential ablation is unnecessary.