经主动脉无冠窦内射频消融局灶性房性心动过速

目的探讨起源于主动脉无冠窦或其邻近组织的局灶性房性心动过速(简称房速)心脏电生理特点及经射频导管消融方法。方法 13例患者男3例,女10例,年龄52.7±9.8岁,阵发性房速病史4.2±4.5年。心房刺激诱发房速后,分析体表心电图P′波特点并于右房及主动脉无冠窦内进行激动标测。均于无冠窦内进行射频消融治疗。结果 13例心房刺激均能反复诱发或终止房速,平均周长340.9±46.0ms,房速时P′波时限77.8±14.4ms,明显短于窦性心律时P波时限111.2±10.3ms(P0.05)。常规激动标测,所有患者于His束处标测到相对提前的心房激动。经主动脉逆行方法 ,所有患者于无冠窦内标测到心房激动较His束处的心房激动提前9.3±6.1ms,放电1～2次于2～8s内终止房速。随访3～36个月,无复发病例及手术相关合并症。结论起源于主动脉无冠窦或其邻近组织的房速具有窄P′波及常规标测相对提前的心房激动位于His束处的特点。经主动脉无冠窦内标测消融是一种根治此类房速安全有效的方法 。     

三维电解剖标测指导射频导管消融治疗起源于主动脉无冠窦房性心动过速

目的探讨起源于主动脉无冠窦房性心动过速（房速）的电生理特征及三维激动标测指导射频导管消融治疗无冠窦房速的安全性和有效性。方法43例局灶性房速经普通电生理检查及三维电解剖激动标测明确起源于无冠窦者7例。结果7例患者均于心动过速发作时消融10s内心动过速终止。所有患者于消融即刻心动过速终止或出现心动过速加速。在（20±6）个月的随访中心动过速未复发。结论三维激动标测指导射频导管消融治疗起源于主动脉无冠窦房速是安全有效的。     

主动脉无冠窦内和二尖瓣环-主动脉连接处射频导管消融局灶性房性心动过速

目的报道13例主动脉无冠窦内和1例二尖瓣环一主动脉连接（MAAJ）处成功消融局灶性房性心动过速（房速）,探讨该类房速的电生理特点及标测和消融方法。方法14例患者,男性3例女性11例,平均年龄（54．4±10．4）岁,均有阵发性房速病史。心房刺激诱发房速后,分析体表心电图P’波特点并于右心房进行激动标测,如果最早心房激动邻近希氏束附近,少数患者在此处消融,其他患者和上述消融不成功患者,经主动脉逆行途径,在无冠窦内标测和消融。如果消融不能成功,则经房间隔穿刺途径至左心房标测最早激动部位处消融。结果房速发作时体表心电图P’波明显变窄（77．8±14．4）ms。右心房激动标测均在希氏束附近标测到相对提前的心房激动,3例于此处消融失败。14例经主动脉逆行途径于无冠窦内标测到最早心房激动提前希氏柬处心房激动0～20．0（10．1±6．3）ms,13例于无冠窦内消融成功,包括1例改用盐水灌注导管后消融成功。1例经无冠窦消融失败后,经穿刺房间隔于MAAJ处标测到最早心房激动处消融成功。随访3～38个月,均无复发。结论对于具有窄P’波及标测右心房最早激动位于希氏束附近的局灶性房速,经主动脉逆行途径在无冠窦内标测和消融具有很高的成功率,经穿刺房间隔在左侧MAAJ处消融或应用盐水灌注导管无冠窦内消融可能进一步提高消融成功率。     

无冠窦射频消融房速1例

患者女,63岁。因"阵发性心悸5年,加重10天"入院。患者5年前无明显诱因开始出现心悸,心率160bpm,伴有胸闷、气短,平均每月发作2次,每次持续2h左右,曾就诊于当地医院,给予维拉帕米治疗后好转。10天前,患者无明显诱因再次出现心悸,心率最快达180bpm,持续时间达6h,应用维拉帕米疗效不明显。发作频繁,平均每2天发作1次,每次持续     

射频消蚀术治疗房性心动过速

５例房性心动过速（房速）行射频消蚀术，男２例，女３例，平均年龄４９岁。方法是用二根大头消蚀导管标测心房，在初定房速部位交替、移动标准，Ａ波出现最早处射频放电。结果：５例均为右房房速，２例为自律性房速，３例为房内折返性心动过速。射频消蚀的靶点，２例在冠状窦口上方，１例在冠状窦口下方，１例在右房中侧壁，１例在上侧壁，靶点处Ｐ－Ａ为－２５￣－４０ｍｓ；５例射频消蚀全部成功，随访１￣８个月无１例复发。初步     

房性心动过速的导管射频消融术治疗

目的:探讨房性心动过速(房速)行导管射频消融术(RFCA)治疗方法、疗效及其安全性。方法:选择24例经心内电生理检查证实为房速并同意行RFCA治疗患者,常规电生理检查分别在高位右房(HRA)、右室心尖部(RVA)2个部位行S1S1刺激和程控期前收缩刺激,记录房速的诱发和终止方式。靶点标测采用激动标测法,单根消融导管于右房或左房(经房间隔穿刺)内标测寻找最早心房激动或用多极导管作为参考电极,再用大头导管寻找消融靶点。根据消融结果,分析房速的起源部位、消融即时成功率、并发症、复发原因以及X线曝光时间等。结果:24例房速患者中,22例(88%)右房房速,3例(12%)左房房速(1例患者同时存在左、右房2个部位房速)。4例与其他心律失常合并存在,1例房室结折返性心动过速,1例合并房性折返性心动过速,1例合并心房颤动,1例同时合并心房扑动和心房颤动。24例患者均完成射频消融治疗(实际消融25例次),均采用温控消融,按预定消融终点,23例次即时消融成功,即时成功率92%(23/25),平均X线曝光时间(32±6.4)min,消融失败2个病例中,右房房速和左房房速各1例,再次消融成功。未发生房室传导阻滞、心包填塞等严重并发...     

射频消融治疗房性心动过速

导管射频消融术（ＲＦＣＡ）治疗房室折返性心动过速（ＡＶＲＴ）和房室结折返性心动过速（ＡＶＮＲＴ）已十分成熟。房性心动过速（ＡＴ）在临床上较少见且药物难以控制,ＲＦＣＡ治疗房速的报道也较少［１］,其成功率在６０％～９０％。作者总结了４例房速的ＲＦＣＡ,...     

射频导管消融术治疗房性心动过速23例分析

目的：分析房性心动过速（房速）的电生理特点,探讨射频导管消融术在房速治疗中的价值。 方法：对２３例房速患者进行心电生理检查和射频导管消融治疗。 结果：２３例患者中,２０例为折返性房速,３例为自律性增高性房速。２３例患者,２１例消融成功,其中１９例成功靶点位于右心房,２例位于左心房。成功靶点 ＰＡ为－６０～－２５ ｍｓ,平均－３６ ｍｓ。 结论：射频导管消融术是治疗房速的安全有效的方法。     

起源于主动脉窦内的房性心动过速、频发室性早搏的射频消融治疗

目的报道4例局灶性房性心动过速（房速）,3例频发室性早搏（室早）经主动脉途径在左冠窦和无冠窦内标测和射频消融的结果。方法对4例房速、3例频发室早进行常规心电图、心内电生理检查和射频消融治疗。结果4例阵发性房速患者的标测靶点位于主动脉窦内,在无冠窦成功消融;3例频发室早在左冠窦内标测及消融成功。术中无并发症,随访3～31个月,无1例复发。结论在主动脉无冠窦、左冠窦内射频消融是可行的且能达到安全、有效的治疗目的。尤其适用于在常规、经典部位消融失败的患者。     

主动脉无冠窦内射频消融前间隔房室旁路

目的 报道经主动脉无冠窦内射频消融前间隔房室旁路.方法 7例患者,男性4例,女性3例,平均年龄（38.4±14.7）岁.电生理检查证实存在房室旁路,并检查其前传逆传功能和诱发旁路参与的房室折返性心动过速.在心动过速时标测最早心房逆传激动点作为消融靶点.结果 7例心动过速时最早心房激动部位均位于前间隔区域,但经右心房途径反复消融均不能成功阻断旁路,而在无冠窦内可标测到最早逆传心房激动点并消融成功,无并发症出现.结论 主动脉无冠窦内消融可作为治疗前间隔房室旁路的一种新途径,特别适用于右心房前间隔区域消融失败的病例.     

经主动脉无冠状窦内射频消融治疗房性心动过速

目的:报告经主动脉无冠状窦内射频消融6例局灶性房性心动过速(房速)的消融结果。方法:6例患者中男女各3例。阵发性房速病史(6±3)年。常规心电图、心内电生理,术中心房和心室刺激诱发房速,分别在右心房、左心房和主动脉无冠状窦内标测最早心房激动,并进行射频消融。结果:心房刺激能反复诱发和终止6例患者的房速。心房内的前间隔部位标测相对提前的心房激动,但多次消融未成功。经主动脉无冠状窦内消融成功。平均随访3~17个月,无1例房速复发。结论:经主动脉无冠状窦消融前间隔房速是安全,有效的。     

Successful catheter ablation of focal atrial tachycardia from the non-coronary aortic cusp.

We describe a patient with frequent episodes of unusual paroxysmal supraventricular tachycardia. During the electrophysiological examination, the tachycardia was easily induced and terminated by atrial pacing. The earliest activation during right atrial activation mapping was located near the atrioventricular node and the His bundle. However, detailed mapping of the aortic root demonstrated that the local activation in the non-coronary aortic cusp preceded the activation at the His bundle region. Radiofrequency catheter ablation at this site terminated the tachycardia with no complications.     

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。     

主动脉无冠状窦内射频导管消融前间隔局灶性房性心动过速

目的报告经主动脉无冠状窦内射频消融8例前间隔局灶性房性心动过速(房速)。方法8例患者男性3例,女性5例,平均年龄(50．6±12．3)岁。阵发性房速病史(7．5±5．5)年。术中心房和心室刺激诱发房速,分别在右心房、左心房和主动脉无冠状窦内标测最早心房激动,并进行消融。结果心房刺激能反复诱发和终止8例患者的房速,房速的平均周长(329±66)ms。右心房和左心房的前间隔部位标测相对提前的心房激动,但多次消融未成功。主动脉无冠状窦内的心房激动较希氏束处的心房波提前(11．6±7．2)ms,放电1～2次于8s内终止8例房速。随访(10．2±4．8)个月,无一例房速复发。结论主动脉无冠状窦内可作为消融前间隔局灶性房速的一种新途径,尤其适用于在希氏束部位消融失败的患者。     

Catheter ablation of peri-AV nodal atrial tachycardia from the noncoronary cusp of the aortic valve

Introduction: Atrial tachycardias (AT) originating from the anteroseptal region of the aortic root, near the atrioventricular node can be challenging to eliminate safely by catheter ablation. In this study, we examine the characteristics of anteroseptal ATs in a cohort of patients at our centers, and demonstrate the long-term efficacy and safety of targeting the arrhythmias from within the base of the noncoronary aortic valve cusp (NCC).
Methods & Results: From among a cohort of 54 patients with symptomatic focal AT undergoing invasive electrophysiological evaluation, the point of earliest right atrial (RA) activation was at the peri-AV nodal region in 10 patients, just postero-superior to the His-bundle. Before further mapping, RA lesions placed in two patients were unsuccessful in eliminating the arrhythmia. Because of its proximity to the interatrial septum, the base of the NCC was mapped using a retrograde aortic approach, and revealed a point of early activation without the presence of a His potential. The arrhythmia terminated with <10 seconds of radiofrequency or cryothermal energy delivery and was successfully eliminated in 7 of 10 patients. Transient termination or acceleration of the AT was noted in the other three patients, prompting successful ablation from a left atrial septal position or a reattempt from a para-Hisian RA position. All patients have been arrhythmia free during follow-up (41 ± 12 months).
Conclusions: Catheter ablation from within the base of the NCC represents a safe and effective means to eliminate focal AT arising from the peri-AV nodal region.     

Radiofrequency catheter ablation of atrial tachycardia

Background: Atrial tachycardia is a relatively uncommon arrhythmia which usually responds poorly to antiarrhythmic drug therapy. Transcatheter radiofrequency (RF) ablation is a new therapeutic modality for patients with atrial tachycardia. Aim: This study analyses our early experience with the treatment of atrial tachycardia by this technique. Methods: Thirteen consecutive patients (age 13–63 years) with 15 drug-refractory atrial tachycardia foci were treated with RF catheter ablation. Atrial tachycardia was mapped by seeking the earliest atrial activation in the right atrium in eight patients and in the left atrium in five. Results: Tachycardias were abolished in nine (69%) patients, including two sinoatrial re-entrant tachycardias and seven automatic atrial tachycardias, after 9±10 (range, one to 28) pulses of RF current. Six of these ablated atrial tachycardia foci were right sided and three were on the left. One patient had three separate right atrial tachycardia foci; one was eliminated. Tachycardia recurred after two weeks in one patient with apparently successful ablation of sinoatrial re-entrant tachycardia. One patient with successful ablation of a right atrial tachycardia developed cardiac tamponade requiring surgical intervention. Conclusion: This study demonstrates that atrial tachycardia arising from diverse sites can be eliminated by RF catheter ablation.     

Reentrant ventricular tachycardia originating from the aortic sinus cusp: a case report

We report a case of idiopathic reentrant ventricular tachycardia (VT) originating from the left aortic sinus cusp. A prepotential preceding the QRS complex by 58 ms was recorded from the posterior right ventricular (RV) outflow tract. During VT entrainment observed by pacing from the midseptal RV, it initially was orthodromically captured with a long conduction time but then antidromically captured as the pacing cycle rate was increased. Pacing at that site failed to show concealed entrainment despite a postpacing interval similar to the VT cycle length. Radiofrequency catheter ablation abolished the VT in the left aortic sinus cusp where a prepotential preceding the QRS complex by 78 ms with a postpacing interval similar to the VT cycle length was recorded in addition to concealed entrainment. The findings suggest that, in this VT, a critical slow conduction zone is partially present extending from the left aortic sinus cusp to the posterior right ventricular outflow tract. The patient has remained free from VT recurrence after 5-month follow-up.