房性心动过速后伴电张调整性T波改变

患者女性,61岁,因阵发性心悸30余年,“心绞痛”史半年入院。体检:BP120/80mmHg(16/10.8kPa),心界不大,心率69次/min,律齐,心音强,心脏无病理性杂音。入院后检查:UCG心脏正常,X线心脏三位片、心肌核素显像均未见异常,左室及冠状动脉造影正常,运动试验阴性,Holter示偶发房性早搏及室性早搏,无ST-T异常变化。心动过速发作时心电图(附V_1(?)     

子宫收缩致一过性窦性心动过速及T波改变1例

患者女性,29岁.因孕40周,每3min子宫收缩1次、全身出汗收入我院妇产科.体检:心界不大、BP16/10kPa(120/75mmHG),T36℃.心率48次/min,心律齐,无病理性杂音,两肺无殊.临床诊断;妊娠40周,胎儿宫内窘迫.心电图检查(图1A)示窦性心律.49次/min,Ⅱ、Ⅲ、aVF、V_4～V_6导联T波低平.心电图诊断:窦性心动过缓,T波改变.急诊行剖宫产术,术中顺利,新生儿正常.术后窦性心动过速(111次/min)T波恢复正常(图1B).翌日动态心电图正常,SDNN147(正常值141±39)ms.随访半年未出现窦性心动过缓及T波改变(图略).     

短阵房性心动过速发生规律探讨

目的 了解短阵房性心动过速(PAT)发生规律。方法 应用24h动态心电图(DCG)连续监测心脏节律的变化。结果 564例中发生PAT 127例,检出率22．5％。PAT发生时间规律为夜间少,白天多,中午迭高峰。集中趋势在中午12时30分左右。非卧床状态下发生阵数量是卧床休息状态下的2.2倍。检出率随年龄而增加。结论 PAT的发生可能与植物神经如交感神经及副交感神经能力变化的影响有关。     

窦性P波电轴显著左偏伴房性并行心律性心动过速1例

患者女性,73岁。因“心律不齐”于2007年4月7日作心电图检查。临床未提示有器质性心脏病证据。图1示Ⅱ导联。P1-4,9波按序出现,P波呈“正负”双向,结合PaVR倒置、Pv5,6直立（图略）,可判为窦性起源伴P波电轴显著左偏（-30°）。P—P间距0．84—0．90s（66—71次／分）,下传QRS波呈Rs型,外形正常,P—R间期0．14s。     

阵发性室性心动过速终止后T波改变1例

患者男,42岁。心悸发作持续36h不能缓解入院。患者反复心悸2年,多于餐后发作,每次持续30min—4h不等,2—3个月发作1次。体检:BP14.0/8.8kPa(105/66mmHg)。神志清,平卧位,双肺呼吸音清晰,心率160次/min,心律齐,未闻及病理性杂音。X线胸片未见异常,超声心动描记术示各房室大小正常,各瓣膜无异常,心室舒缩功能正常。心肌酶:CK240U/L,CK-MB30U/L,LDH380U/L。(正常值     

宽大P波与房性心动过速关系的探讨

目的探讨宽大P波与房性心动过速的关系。方法测量常规12导心电图的P波时限,分为P波正常组（A组）30例和P波宽大组（B组）32例,将两组的12导DCG资料进行回顾性分析。结果A组发生房性心动连速9例,占30％,B组发生房性心动过速24例,占75％,两组比较P〈0．01。结论宽大P波与房性心动过速有密切关系。     

低血钾时房性心动过速后U波异常增大1例

患者男性 ,７０岁。因阵发性心悸伴胸痛２天入院 ,临床诊断 :冠心病 ,心律失常。心电图(图１Ａ)示Ｕ波增大 ,提示低钾血症。实验室检查 :血清Ｎａ １４２ｍｍｏｌ／Ｌ ,Ｋ ２．０５ｍｍｏｌ／Ｌ ,Ｃｌ２ １０３ｍｍｏｌ／Ｌ。当天２４ｈ动态心电图 (图１Ｂ)示 :房性期前收缩７６７２次 ,其中房性心动过速１８４阵次。在每次房性心动过速终止后初始几次窦性心搏Ｕ波异常增大 ,且与心动过速持续时间有关 ,其最长一次 (持续２０ｓ)终止后Ｕ波骤增至１．３ｍＶ ,并逐渐恢复 (０．６→０．５→０．３ｍＶ) ,按冠心病给以常规治疗 ,并积极纠正…     

长间歇后的窦性心律伴巨大T波

病例摘要患者女，74岁，“风湿性心脏病”20年，近1个月反复黑蒙、心悸。12导联心电图显示：窦性心律，短阵房性心动过速。房速终止后的第一个窦性心律伴巨大直立的T波(图A、图B)，T波方向与QRS波主波方向一致。同时伴QT间期延长。心电图诊断：①窦性心律；②短阵房速后伴巨大T波及QT间期延长。同一天记录的动态心电图中上述现象多次重复出现。     

特发性室性心动过速后伴电张调整性T波改变

患者男,24岁。因阵发性心悸5年,持续性发作1天收治。5年中曾发作5次,每次持续数h至1天,发作时心率140—160次/min,除心悸外无其他不适感。曾作超声心动描记术、X线胸片等检查未发现异常。此次发作无明显诱因,BP13/10kPa(98/75mmHg),门诊静脉注射普罗帕酮70mg后不见好转。入院时心电图(附图上)各导联R-R间期规整,其间夹有窦性P波,P与QRS无关,心室率大于心房率,QRS时间0.14s,电轴—82°,频率150次/min,Ⅱ、Ⅲ、aVF呈rS型,V_1呈qR型,R波宽大畸形,V_5、V_6呈rS型,S波宽大,表现为右束支传导阻滞     

特发性室性心动过速伴电张调整性T波改变

例1 患者男性,31岁,因心悸3天入院。无心肌炎、心肌病、高血压等病史。体格检查:BP110/68mmHg(14.6/9kPa),心脏不大,心律规则,心率136次/min,无心脏杂音。ECG 示室速。UCG 示心脏正常。室速发作时心电图(图1A)示:QRS 宽0.12s,心率130次/min,呈RBBB 型,T 波与QRS 主波方向相反。室速发作后ECG(图1B)示:窦性心律,心率77次/min,     

冠状静脉窦不同部位起搏拖带心动过速对房性心动过速的诊断价值

目的:探讨心动过速时分别在冠状静脉窦近端(CSp)和远端(CSd)快速起搏拖带心动过速的操作方法鉴别房性心动过速(AT)的价值。方法:入选67例室上性心动过速患者,在心动过速时分别以短于心动过速周长10~40 ms的间期起搏CSp和CSd,确认夺获心房后停止起搏。如果心动过速不终止,测量每次起搏停止后的第一个QRS波群起始至第一个自身A波的间期(VA间期),计算两个VA间期差值(DVA)。结果:67例患者平均年龄(41±17)岁,其中15例为AT患者,25例为房室结内折返性心动过速患者,27例为房室折返性心动过速患者(后两类患者为非AT患者)。AT患者的DVA[(79±29)ms]大于非AT患者[(4±2)ms],差异有统计学意义(P<0.01)。所有AT患者的DVA均>10 ms,而非AT患者中无一例DVA>10 ms。结论:在冠状静脉窦不同部位起搏拖带心动过速,计算停止起搏后第一个DVA是一种快速、简单、有效的诊断或除外AT的方法,在使用较少标测电极时更为实用。     

Iterative Atrial Tachycardia Originating from the Coronary Sinus Musculature

A case of iterative atrial tachycardia leading to dilated cardiomyopathy is reported. During electrophysiologic study, the tachycardia showed a markedly irregular cycle length associated with changes in atrial activation breakthrough as demonstrated by coronary sinus (CS) recordings and frequently degenerated into self-terminating atrial fibrillation. Left atrial transseptal mapping demonstrated the earliest endocardial atrial activation close to the posterolateral mitral annulus, but this was invariably later than that recorded within the CS, where low-energy radiofrequency applications eliminated the tachycardia. No acute vessel damage was observed at postablation CS angiography. In accordance with previously published experimental data, we hypothesized that the muscular sleeves surrounding the CS might be involved in the genesis of this tachycardia. During 6-month follow-up, the patient remained asymptomatic without tachycardia recurrences and with complete recovery of left ventricular function, confirming the reversible nature of the tachycardia-induced cardiomyopathy.     

心房颤动导管消融术后快速性房性心律失常的机制和治疗

随着心房颤动导管消融治疗的日益广泛开展,导管消融术后快速性房性心律失常（即继发性房性心律失常,包括房性心动过速和心房扑动）逐渐成为临床心律失常治疗的关注热点,其机制在不同患者中不尽相同,甚至同一患者亦可涉及多种机制,因此这种心律失常的处理可能较心房颤动本身更为棘手。现就心房颤动导管消融术后发生快速性房性心律失常的可能机制及其防治策略作一综述。     

Focal Atrial Tachycardia:

Atrial Tachycardia. Introduction : Reports about the clinical and electrophysiologic characteristics of focal atrial tachycardia vary widely. Furthermore, the impact of age, gender, associated cardiac diseases, mechanism, location of atrial tachycardia, and the prediction of results of radiofrequency catheter ablation was not clear. The purpose of this study was to further understand the clinical and electrophysiologic characteristics of focal atrial tachycardia and the prediction of results of radiofrequency ablation.
Methods and Results: We searched the literature published between January 1969 and July 1997 using the key word "atrial tachycardia" from the MEDLINE and National Library of Medicine systems. The items analyzed were age, sex, cardiac disease, mechanism, attack pattern, cycle length, location, number of atrial tachycardias, results of ablation, and recurrence after ablation. Multivariate analysis showed that age and paroxysmal type of tachycardia were independent predictors of nonautomatic mechanism; age and presence of other cardiac diseases were independent predictors of multiple atrial tachycardias, and age also was the independent predictor of right-sided atrial tachycardia. Atrial tachycardia located in the right atrium was the only significant predictor of successful radiofrequency catheter ablation. Other cardiac diseases and multiple atrial tachycardias were the significant predictors of recurrence after initial successful radiofrequency catheter ablation.
Conclusion : Patient age is closely related to the clinical and electrophysiologic characteristics of atrial tachycardia based on our reanalysis, which found that patient age is an independent predictor of nonautomatic mechanism, right atrial location, existence of multiple atrial tachycardias, and recurrence of atrial tachycardia after initial successful ablation.     

Atrial Tachycardia Confined Within the Left Atrial Appendage

AT Confined Within the LAA. Left atrial tachycardias are often seen following catheter ablation of persistent atrial fibrillation (AF). We report here an unusual case where AF was converted to sinus rhythm following catheter ablation, but ongoing atrial tachycardia confined within the left atrial appendage (LAA) was observed. Although the LAA tachycardia was dissociated from the atrium in sinus rhythm, bidirectional conduction between the left atrium and the LAA was, however, demonstrated after tachycardia termination. (J Cardiovasc Electrophysiol, Vol. 21, pp. 933‐935, August 2010)     

Atypical Atrioventricular Nodal Reentry Tachycardia with Atrioventricular Block Mimicking Atrial Tachycardia:

AVNRT Mimicking Atrial Tachycardia, Introduction : Fast-intermediate form AV nodal reentry tachycardia (AVNRT) sometimes may mimic atrial tachycardia or atrial flutter and render the diagnosis difficult when the tachycardia rate is fast and AV block occurs during tachycardia.
Methods and Results : A 45-year-old woman with paroxysmal supraventricular tachycardia was referred to this institution. Initially, the tachycardia was thought to be an atrial tachycardia because of: (1) a short cycle length of the tachycardia with 2:1 and Wenckebach AV block; (2) a difference in the atrial activation sequence during tachycardia and during ventricular pacing; and (3) failure of burst ventricular pacing to affect the atrial rate and the atrial activation sequence during tachycardia. An accurate diagnosis of fast-intermediate form AVNRT was subsequently made based on the finding that the tachycardia was induced following delivery of a third ventricular extrastimulus, which showed a sequence of V-A-H and a change on atrial activation sequence of the induced beat. Successful radiofrequency ablation was achieved only after accurate diagnosis of the tachycardia was made.
Conclusion : Fast-intermediate form AVNRT sometimes may masquerade as atrial tachycardia. Accurate diagnosis is mandatory for successful ablation therapy.     

Clinical Significance of Early Recurrences of Atrial Tachycardia After Atrial Fibrillation Ablation

Early Recurrence After AF Ablation. Background: Atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT. Methods: Of 352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for AF, 56 patients (15.9%) with ERAT were identified by retrospective analysis. ERAT was defined as early relapse of AT within a 3‐month blanking period after ablation. Results: During 21.7 ± 12.5 months, the rate of late recurrence was higher in patients with ERAT (41.1%) compared with those without ERAT (11.8%, P < 0.001). In a multivariable model, positive inducibility of AF or AT immediately after ablation (65.2% vs 36.4%, P = 0.046; odd ratio, 3.9; 95% confidence interval, 1.0–14.6) and the number of patients who underwent cavotricuspid isthmus (CTI) ablation (73.9% vs 42.4%, P = 0.042; odd ratio, 4.5; 95% confidence interval, 1.1–19.5) were significantly related to late recurrence in the ERAT group. The duration of ablation (174.3 ± 62.3 vs 114.7 ± 39.5 minutes, P = 0.046) and the procedure time (329.3 ± 83.4 vs 279.2 ± 79.7 minutes, P = 0.027) were significantly longer in patients with late recurrence than in those without late recurrence following ERAT. Conclusions: The late recurrence rate is higher in the patients with ERAT compared with those without ERAT following AF ablation, and is more often noted in the patients who underwent CTI ablation and had a prolonged procedure time. Furthermore, inducibility of AF or AT immediately after ablation independently predicts late recurrence in patients with ERAT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1331‐1337, December 2010)     

Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation in Patients with Lone Atrial Fibrillation and Patients with Hypertension

Background: The success rate and prognosis of cardioversion of atrial fibrillation (AF) in patients with organic heart disease is well known. In contrast, little data exist about cardioversion success and maintenance of sinus rhythm (SR) in patients with lone AF and in patients with hypertension as the only underlying cardiovascular disease. Methods: In a prospective cardioversion registry 148 of 181 patients (81.8%) with lone AF (age 58 ± 13 years, duration of AF 7.6 ± 19 weeks) and 120 of 148 patients (81.1%) with hypertension (age 62 ± 10 years, duration of AF 6.6 ± 21 weeks) had successful cardioversion and were followed for 7.7 ± 1.9 months. Results: At follow-up, 120 patients (81.1%) with lone AF were in SR, and 18 of these patients had had repeated cardioversion during follow-up (AF total recurrence rate 31.1%). In stepwise regression analysis, the number of previous cardioversions was predictive of rhythm at follow-up (P = 0.0453). Rhythm at follow-up did not differ between patients who were or were not on antiarrhythmic drugs. At follow-up 96 patients (80%) with hypertension were in SR, and 9 of these had had repeated cardioversion during follow-up (AF total recurrence rate 27.5%). As in lone AF, the recurrence rate of AF did not differ between patients with or without antiarrhythmic drug treatment, and in multivariate regression analysis, the number of previous cardioversions was the only clinical predictor of rhythm at follow-up (P = 0.0284). Conclusions: Even in patients with such benign conditions as lone AF or hypertension as the only underlying disease, the prognosis of cardioversion in terms of maintenance of SR is poor. Future studies of rhythm control versus rate control need to include not only patients with organic heart disease but also patients with lone AF and patients with hypertension, since the long-term benefits of these two strategies remain unclear even in these subsets of patients.     

Outcome of Ablation for Sustained Focal Atrial Tachycardia in Patients With and Without a History of Atrial Fibrillation

Objectives: The aim of this study was to determine the long-term results of ablation for sustained focal atrial tachycardia in patients with and without a history of atrial fibrillation.Methods: A history of atrial fibrillation was documented in 25 of 111 patients (23%) with focal atrial tachycardias. We studied the results of focal ablation during a follow-up of 27 ± 22 months.Results: Enlargement of left atrium (Odds ratio 2.99) and septal origin of the atrial focus (Odds ratio 5.68) were independent predictors of coexisting atrial fibrillation. Patients with a septal origin of the focal atrial tachycardia were older (62 vs. 54 years) and had a higher rate of structural heart disease than patients with a non-septal site of origin (51 vs. 29%). A higher rate of atrial fibrillation was found in patients with anteroseptal (56%), midseptal (50%) and posteroseptal (36%) atrial tachycardias than in patients with focal atrial tachycardias arising from the crista terminalis (9%), the tricuspid (12%) and mitral annulus (0%), the ostia of thoracic veins (17%) and other right atrial (27%) and left atrial free wall sites (10%). During the follow-up, atrial fibrillation was documented in 3% of patients without preexisting atrial fibrillation. In patients with focal atrial tachycardia and a history of atrial fibrillation, at least one episode of atrial fibrillation was documented during follow-up in 64% of patients, but 60% of patients reported marked symptomatic improvement.Conclusion: An increased rate of coexisting atrial fibrillation was found in patients with a septal origin of focal atrial tachycardia. Ablation of the focal atrial tachycardia may eliminate both arrhythmias, but patients with a history of atrial fibrillation may still be prone to recurrences of atrial fibrillation after focal ablation.