His束旁起源房性心动过速的电生理特征及射频消融

目的回顾性分析His束旁房性心动过速(简称房速)的心电生理特征并探讨射频消融策略。方法连续入选经心电生理检查和射频消融证实起源点位于His束旁的房速,对患者的临床特征、心电生理特点及射频消融策略进行回顾性分析。结果共入选23例,其中男7例,女16例,年龄(59.9±16.6)岁,病史6个月至5年。His束旁房速女性较男性多见,20例为阵发性, 3例为无休止心动过速。所有患者的心电图特征为:P波窄而低幅,Ⅱ、Ⅲ、aVF和V_1导联P波负正双向,Ⅰ、aVL导联直立,V_2～V_6导联P波负向。右房激动标测示心内最早激动位于His束附近,仅比冠状窦近端提前(15±3)ms(始终找不到最早提前的A波),20例于右房His束旁消融成功,3例于主动脉无冠窦内消融成功,均无并发症。结论 His束旁房速有独特的心电图特征及心房内激动顺序,经右房His束旁消融治疗是安全有效的方法。     

希氏束旁起源房性心动过速心电生理特征及射频消融疗效

目的分析起源于希氏束旁房性心动过速(房速)的心电生理特征及射频消融治疗效果。方法选自2009年1月至2014年5月在首都医科大学附属北京安贞医院心内科就诊的经心内电生理检查和射频消融证实起源点位于希氏束旁的房速,简称希氏束旁房速18例,其中男2例,女16例,年龄31~68(40±9)岁,病史1~10年。对患者临床特征、心电生理特点及射频消融疗效进行分析。结果希氏束旁房速大多为女性,16例表现为阵发性,为心房或心室程序刺激诱发和终止,2例为无休止心动过速。所有患者房速心电图P波窄而低幅,Ⅱ,Ⅲ,a VF和V1导联P波负正双向,Ⅰ、a VL导联为直立,V2~V6导联P波负向。右房激动标测示心内最早激动位于希氏束附近,并领先于体表P波起始(15±3)ms。16例患者于无冠窦内消融成功,2例于右房希氏束旁消融成功,均无并发症,随访12个月所有患者均无心动过速复发。结论希氏束旁房速有独特的临床特征,心电图特征及心房内激动顺序,应首选无冠窦途径消融,长期随访房速行射频消融治疗安全有效。     

无冠窦起源房速的电生理特征与射频消融

目的进一步分析起源于主动脉无冠窦房性心律失常的心电生理特征及射频消融治疗。方法11例患者经心内电生理检查和射频消融证实的起源于主动脉无冠窦局灶性房速,对其临床特征,心电生理特点及射频消融进行分析。结果无冠窦房速大多为女性,表现为阵发性,为心房或心室程序刺激诱发和终止。所有患者房速心电图P波窄而低幅,Ⅱ,Ⅲ,aVF和v,导联P波负正双向,Ⅰ,aVL导联直立,V2～V6导联P波负向。心内最早激动位于希氏束远端,并领先于体表P波起始（15±3）ms。无冠窦内标测最早激动等于或早于希氏束远端,局部电位特征为大A小V（或大V）,无希氏束电位,11例患者无冠窦内放电均在8秒内终止心动过速,均无并发症,无抗心律失常药物随访12±5月所有患者均无心动过速复发。结论主动脉无冠窦房速有独特的临床特征,心电图特征及心房内激动顺序,长期随访这类房速射频消融有良好的治疗效果。     

起源于左心耳局灶性房性心动过速的电生理特征和射频消融治疗

目的 报道一组起源于左心耳局灶性房性心动过速(房速)的电生理特征和射频消融治疗.方法 9例患者中男性5例,平均年龄(21±9)岁,经心内电生理检查和射频消融证实为起源于左心耳的房速,对其电生理特点及射频消融进行分析.结果 左心耳房速表现为无休止性或静脉滴注异丙肾上腺素诱发,程序刺激不能诱发或终止房速.左心耳房速有独特的体表心电图特征,所有患者P波Ⅰ、aVL导为负向,Ⅱ、Ⅲ、aVF导联P波高而直立.V_1导P波为直立或正负双向(以直立为主),V_2～V_6导P波为等电位线(5例)或<0.1 mV低幅直立(4例).常规心内标测,最早心房激动为CS远端.成功靶点处局部心房激动领先P波起始(36.7±7.9)ms.5例患者最终使用盐水灌注导管消融成功,随访(12 ±5)个月无房速复发.结论 左心耳房速有独特的心电图特征和房内激动顺序,对这类房速盐水灌注导管可能是更好的选择,左心耳内局灶消融长期随访安全有效.     

三尖瓣环游离壁起源房速的电生理特征

目的报道一组起源于三尖瓣环(TA)游离壁房性心律失常的心电生理特征及射频消融治疗。方法7例患者经心内电生理检查和射频消融证实的起源于三尖瓣环游离壁的房性心律失常,对其心电生理特点及射频消融进行分析。结果三尖瓣环房速表现为阵发性,为心房程序刺激诱发(4例)或静滴异丙肾上腺素后自发(3例)。三尖瓣环房速有独特的体表心电图特征,所有患者I,aVL导联P波直立,TA11点起源房速II,III,aVF导联P波直立;TA9点起源房速II,III,aVF导联P波低幅直立;TA7点起源房速II,III,aVF导联P波倒置。TA11点起源房速胸导V1导为负向,V2～V6导P波逐渐移行为正向。其余部位TA房速V1～V6P波均为负向。7例患者均消融成功,随访12月均无房速复发。结论三尖瓣环房速有独特的心电图特征和房内激动顺序,长期随访这类房速射频消融有较好的治疗效果。     

源于肺静脉口部的房性心动过速P‘波形态和射频消融 …

报道４例源于肺静脉口部房性心动过速（简称房速）的Ｐ‘波形态和射频消融治疗。４例房速患者心电图Ⅱ、Ⅲ、ａＶＦ和Ｖ１导联上Ｐ’波均呈正向：１例左上肺静肺口部房速Ｉ和ａＶＬ导联的Ｐ‘波为负向，另３例右上肺静脉口部房速上述两导联的Ｐ‘波则为正向或双向。４例患者均消融成功，３例患者中被误诊为右房房速并在右房内消融。结果表明Ｐ’波形态对判定房速的起源部位有一定意义，源于肺静脉口部房速的射频消融方法和效果与左房     

源于肺静脉口部的房性心动过速P'波形态和射频消融治疗

报道４例源于肺静脉口部房性心动过速（简称房速）的Ｐ波形态和射频消融治疗。４例房速患者心电图Ⅱ、Ⅲ、ａＶＦ和Ｖ１导联上Ｐ波均呈正向；１例左上肺静脉口部房速Ⅰ和ａＶＬ导联的Ｐ波为负向，另３例右上肺静脉口部房速上述两导联的Ｐ波则为正向或双向。４例患者均消融成功，３例患者术中被误诊为右房房速并在右房内消融。结果表明Ｐ波形态对判定房速的起源部位有一定意义；源于肺静脉口部房速的射频消融方法和效果与左房其他部位的房速相同     

经射频导管消融起源于心耳的局灶性房速

目的起源于左、右心耳处的局灶性房性心动过速(房速)比较少见,本研究报告14例起源于左、右心耳的局灶性房速的电生理特性和射频导管消融结果。方法 14例患者年龄为12～55岁,均有反复发作心悸和心动过速的病史,11例心动过速呈无休止发作,抗心律失常药物难以控制,其中3例伴明显左心室增大。电生理检查明确局灶性房速机制,其它机制的室上性心动过速经详细的的电生理检查和心内标测排除。对14例患者均在房速时进行体表心电图分析和激动标测,在心动过速时双极和单极标测所示的最早心房激动部位处行射频导管消融。14例患者中,5例应用CARTO三维标测系统引导标测和消融;除3例患者外,其他11例患者均应用盐水灌注导管消融。结果 10例起源于右心耳的局灶性房速患者,房速时的P’波形态Ⅰ导联和Ⅱ、Ⅲ、aVF导联均为正向波,aVL导联P’波负向、正向、双向者分别是3例、3例和4例;V1导联负向波为主(7/10),V3～V6导联正向波为主(9/10),1例V1～V6导联P波全部为正向波。4例左心耳局灶性房速的P’波形态,Ⅰ和aVL导联均为负向波,Ⅱ、Ⅲ和aVF导联均为正向波,V1～V6导联均为正向波。10例右心耳起源房速均消融成功;4例左心耳起源房速2例消融成功,2例消融失败。14例均无围术期相关并发症发生。在随访期间,右心耳起源房速复发1例,经再次消融成功;其他成功消融患者在未服用抗心律失常药物下无房速复发,3例左心室增大患者随访中左心室基本恢复正常。结论起源于左、右心耳局灶性房速多呈无休止特点,可导致心动过速性心肌病。经射频导管消融心耳部(尤其是右心耳)起源局灶性房速有较高的成功率、较低的复发率和较好的安全性。     

经射频导管消融起源于心耳的局灶性房速

目的起源于左、右心耳处的局灶性房性心动过速(房速)比较少见,本研究报告14例起源于左、右心耳的局灶性房速的电生理特性和射频导管消融结果。方法 14例患者年龄为12～55岁,均有反复发作心悸和心动过速的病史,11例心动过速呈无休止发作,抗心律失常药物难以控制,其中3例伴明显左心室增大。电生理检查明确局灶性房速机制,其它机制的室上性心动过速经详细的的电生理检查和心内标测排除。对14例患者均在房速时进行体表心电图分析和激动标测,在心动过速时双极和单极标测所示的最早心房激动部位处行射频导管消融。14例患者中,5例应用CARTO三维标测系统引导标测和消融;除3例患者外,其他11例患者均应用盐水灌注导管消融。结果 10例起源于右心耳的局灶性房速患者,房速时的P’波形态Ⅰ导联和Ⅱ、Ⅲ、aVF导联均为正向波,aVL导联P’波负向、正向、双向者分别是3例、3例和4例;V1导联负向波为主(7/10),V3～V6导联正向波为主(9/10),1例V1～V6导联P波全部为正向波。4例左心耳局灶性房速的P’波形态,Ⅰ和aVL导联均为负向波,Ⅱ、Ⅲ和aVF导联均为正向波,V1～V6导联均为正向波。10例右心耳起源房速均消融成功;4例左心耳起源房速2例消融成功,2例消融失败。14例均无围术期相关并发症发生。在随访期间,右心耳起源房速复发1例,经再次消融成功;其他成功消融患者在未服用抗心律失常药物下无房速复发,3例左心室增大患者随访中左心室基本恢复正常。结论起源于左、右心耳局灶性房速多呈无休止特点,可导致心动过速性心肌病。经射频导管消融心耳部(尤其是右心耳)起源局灶性房速有较高的成功率、较低的复发率和较好的安全性。     

经主动脉无冠状窦内射频消融房性心动过速四例

4例经主动脉无冠状窦内射频消融成功的房性心动过速(简称房速),其体表心电图P波特点:4例Ⅰ和aVL导联P′波正向;2例Ⅱ、Ⅲ、aVF导联P波呈负正双向,1例呈浅倒置,1例在基线水平;4例V1导联P′波呈负正双向。房速时无冠状窦标测到最早的A波,较His束电位提前15～20ms,较体表P波起始领先32～40ms。在无冠状窦内消融成功,随访3～21个月,房速无复发。     

Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non-coronary sinuses of Valsalva in the aorta

Objectives

Focal atrial tachycardia (AT) arising from non-coronary cusp (NCC) is very rare, and the experience in catheter ablation of this kind of tachycardia remains limited. This study describes the electrophysiologic characteristics and radiofrequency ablation of AT arising from NCC.

Methods and results

The study population consisted of five consecutive patients (three females and two males; age 37–68 years) with AT arising from NCC. The morphology of P waves was described as positive, negative, isoelectric, or biphasic (positive–negative or negative–positive). The atrial mapping was performed during tachycardia to define the earliest atrial activation site. Mean tachycardia cycle length of AT in five patients was 363?±?44 ms. P-wave morphology was predominantly upright or biphasic in lead II, III, and aVF, inverted in aVR. Positive P-wave morphology was seen in lead aVL in all five patients. The precordial leads were negative–positive in V₁ and V₂, negative–positive or positive in lead V₃–V₅, and positive in lead V₆. All the five patients underwent successful radiofrequency ablation within NCC. During a follow up of > 3 months, no patient presented with a recurrence.

Conclusions

This study demonstrated that mapping and ablation of focal AT arising from NCC is safe and effective. When earliest activation was recorded in the proximal electrode of the His-bundle catheter, but radiofrequency ablation in this region cannot successfully eliminated the tachycardia, the AT should be considered to arise from NCC especially when P-wave morphology was initially negative with a late positive component in right precordial leads, upright or biphasic in inferior leads.     

起源于冠状静脉窦口的房性心动过速九例

目的报道9例起源于冠状静脉窦口附近的房性心动过速(简称房速)。方法回顾分析2005年11月至2009年1月行射频消融治疗的59例房速患者,发现9例起源于冠状静脉窦口。其定义为标测的最早激动点位于冠状静脉窦口周1 cm范围以内的区域并在此消融成功。结果9例靶点局部A波激动时间领先体表P波起点39±12(30~53)m s。房速体表P波具有以下特点:Ⅱ、Ⅲ、aVF导联P波呈负向波,I导联呈等电位线或低幅正向波,aVL导联呈正向波,多数病例V1导联P波前半部分为等电位线,后半部分为正向波,胸前导联P波由右向左在V3~V6导联逐渐移行为负向。结论冠状静脉窦口是右房房速的一个重要起源点,其体表心电图有明确特征。     

Focal atrial tachycardia originating from the left atrial appendage: electrocardiographic and electrophysiologic characterization and long-term outcomes of radiofrequency ablation

Introduction: This study sought to investigate electrophysiologic characteristics and radiofrequency ablation (RFA) in patients with focal atrial tachycardia (AT) arising from the left atrial appendage (LAA).
Methods: This study included seven patients undergoing RFA with focal AT. Activation mapping was performed during tachycardia to identify an earlier activation in the left atria and the LAA. The atrial appendage angiography was performed to identify the origin in the LAA before and after RFA.
Results: AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing in any patient. The tachycardia demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P wave was highly positive in inferior leads in all patients. Lead V₁ showed upright or biphasic (±) component in all patients. Lead V₂–V₆ showed an isoelectric component in five patients or an upright component with low amplitude (<0.1 mV) in two patients. Earliest endocardial activity occurred at the distal coronary sinus (CS) ahead of P wave in all seven patients. Mean tachycardia cycle length was 381 ± 34 msec and the earliest endocardial activation at the successful RFA site occurred 42.3 ± 9.6 msec before the onset of P wave. RFA was acutely successful in all seven patients. Long-term success was achieved in seven of the seven over a mean follow-up of 24 ± 5 months.
Conclusions: The LAA is an uncommon site of origin for focal AT (3%). There were consistent P-wave morphology and endocardial activation associated with this type of AT. The LAA focal ablation is safe and effective. Long-term success was achieved with focal ablation in all patients.     

起源于右心耳局灶性房性心动过速电生理特点及射频消融

目的探讨起源于右心耳局灶性房性心动过速（RAAT）心电图、电生理特点及射频消融。方法138例经射频消融治疗的局灶性房性心动过速（房速）中有7例（5．0％）起源于右心耳,通过10极冠状静脉窦（CS）电极导管、高位右心房（HRA）电极导管、希氏束（HBE）电极导管和消融导管（ABL）记录其电生理检查结果、靶点位置,并记录和观察体表心电图房性P波形态（正向、负向、低平和双向）。结果7例RAAT患者平均年龄为（41．1±19．6）岁,病史（5．4±4．0）年,其中男性4例,女性3例。房速持续性4例,阵发性2例,通过心房程序刺激诱发1例。体表心电图房性P波形态特征：所有患者V,导联P波负向,绝大多数下壁导联P波正向或双向,胸前导联P波由负向逐渐变为正向。心内电生理检查提示房速时HRA处A波最早,有效消融靶点较体表心电图P波提前（38．4±12．6）ms。6例患者消融成功,其中4例使用盐水灌注消融导管,随访3～12个月无房速复发,未见并发症发生。结论RAAT相对少见（5．0％）,有特殊的心电图和心内电生理表现,盐水灌注消融导管能提高消融成功率,远期效果好。     

Focal atrial tachycardia arising from the mitral annulus: electrocardiographic and electrophysiologic characterization

OBJECTIVES: The study was done to characterize the electrocardiographic and electrophysiologic features of focal atrial tachycardia originating at the mitral annulus (MA). BACKGROUND: Though the majority of left atrial tachycardias originate around the ostia of the pulmonary veins, only isolated reports have described focal tachycardia originating from the MA. METHODS: Seven patients of a consecutive series of 172 patients undergoing radiofrequency ablation for focal atrial tachycardia are reported. Electrophysiologic study involved catheters positioned along the coronary sinus (CS), crista terminalis (CT), His bundle, and a mapping/ablation catheter. RESULTS: All seven patients had tachycardia foci originating from the superior region of the MA in close proximity to the left fibrous trigone and mitral-aortic continuity. These foci demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P-wave morphology in the precordial leads typically showed a biphasic pattern, with an inverted component followed by an upright component. The P-wave was consistently of low amplitude in the limb leads. Earliest endocardial activity occurred at the His bundle region in all seven patients. In general, CS activation was proximal to distal, and mid-CT activation was earlier than high or low CT. Ablation was successful at the superior aspect of the MA in all patients. CONCLUSIONS: The MA is an unusual but important site of origin for focal atrial tachycardia, with a propensity to be localized to the superior aspect. It can be suspected as a potential anatomic site of tachycardia origin from analysis of P-wave morphology and the atrial endocardial activation sequence map. Using mapping targeted to anatomic structures achieved a high success rate for ablation.     

起源于三尖瓣环非间隔部位的房性心动过速体表心电图特点及射频消融治疗

目的报道起源于三尖瓣环非间隔部位的房性心动过速(简称房速)体表心电图特点及射频消融结果。方法13例房速均被证实起源于三尖瓣环非间隔部位并射频消融成功。影像学消融靶点位于三尖瓣环,局部电图可见A波和V波,且A∶V<2,V波的振幅>0.5 mV。结果9例消融成功部位位于三尖瓣环下侧壁,4例位于三尖瓣环上侧壁,靶点局部A波激动时间领先体表心电图P波起点41±15 ms,AV比值0.5±0.4。三尖瓣环下侧壁起源的房速P波特点:Ⅰ、aVL、aVR导联P波正向,Ⅱ、Ⅲ、aVF导联P波负向,V1～V6导联P波负向。三尖瓣环上侧壁起源的房速P波特点:Ⅰ、aVL导联P波正向,aVR导联P波负向或呈等电位线,Ⅱ、Ⅲ、aVF导联P波低幅正向波或呈等电位线,V1导联负向,胸前导联由右向左P波逐渐移行为正向。结论三尖瓣环非间隔部位是右房房速的一个重要起源点,其体表心电图有明确特征。     

Electrophysiologic characteristics of atrial tachycardia originating from the superior vena cava

Introduction  This study sought to investigate electrophysiological characteristics in patients with focal atrial tachycardia (AT) arising from the superior vena cava (SVC). Methods  This study included five patients undergoing radiofrequency ablation (RFA) with focal AT. Activation mapping was performed during tachycardia to identify an earliest activation in the SVC. Results  AT occurred spontaneously or was induced by isoproterenol infusion. The tachycardia demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P-wave was highly positive in leads I, II, III, aVF in all patients, and isoelectric in lead aVL, lead V1 showed biphasic (positive then negative) component in four of five patients. Lead V2–V6 showed positive component in five patients and isoelectric in one patient. The earliest endocardial activity occurred at the SVC ahead of P-wave in all five patients. Mean tachycardia cycle length was 378 ± 18 ms and the earliest endocardial activation at the successful RFA site occurred 35.3 ± 8.4 ms before the onset of P-wave at 2 ± 1 cm above the SVC–right atrium junction, located at the anterior and lateral wall aspect of the SVC. RFA was acutely successful in all five patients, except one patient accompanied with sick sinus syndrome. Long-term success was achieved in five of five over a mean follow-up of 24 ± 5 months (range 12–36 months). Conclusions  The SVC is an uncommon site of origin for focal AT (1.7%). There were consistent P-wave morphology and endocardial activation associated with this type of AT. The SVC focal ablation is safe and effective. Long-term success was achieved with focal ablation in all patients.