心脏房室瓣周房性心动过速的电生理特征及射频消融治疗

目的报道一组起源于房室瓣环或其邻近心房肌(瓣周)的房性心动过速(房速)。方法16例患者经心电生理检查及射频消融证实为瓣周房速,并对电生理机制、靶点图特征、分布区域等进行分析。结果瓣周房速占同期射频消融治疗房速的23.2%,起源点在左、右侧房室瓣环的分布比为3∶16;体表心电图特征、发生机制与其他房速相比,差异无统计学意义。消融成功靶点均有A、V两种成分,A、V电位幅度之比为2∶3~6∶1,靶点局部A波电位提前于体表心电图P′波20~46(38.6±6.7)ms;瓣环标测和消融成功率87.5%,复发率7.1%。结论瓣周房速在全部房速中占有相当比例,起源点分布右侧显著多于左侧。其电生理机制与其他房速无明显区别,瓣环标测和消融在房速射频消融中有较大的实用价值。

Electrophysiological characteristics of peri-cingulum atrial tachycardia and its treatment with radiofrequency ablation

OBJECTIVE: To analyze the characteristics of atrial tachycardia originating from the atrioventricular cingulum. METHOD: The electrophysiological mechanism, ablation site graph and nerve distribution of 16 cases of atrial tachycardia originating from the atrioventricular cingulum or adjacent atrial muscle which were proved by electrophysiological monitoring and radiofrequency ablation. RESULTS: Atrial tachycardia from peri-cingulum represented 23.2% of atrial tachycardia treated by radiofrequency ablation during the same period. The ratio of left to right atrioventricular cingulum was 3:16. There was no difference of the surface ECG characteristics and electrophysiological mechanism between the atrial tachycardia originating from atrioventricular cingulum and that from other positions. Both A and V components were recorded at all the successful ablation sites. The ratio of amplitude of A to V was between 2:3 and 6:1. Atrial potential in the target site was 20-46 (38.6 +/- 6.7) ms earlier than P'wave in surface ECG. The success rate of ablation was 87.5% and the recurrent rate 7.1%. CONCLUSIONS: Peri-cingulum atrial tachycardia accounts for a certain proportion in all atrial tachycardia. The exciting sites originating from right cingulum are more common than those from left cingulum. Its electrophysiological mechanism has no difference from other positions. Cingulum mapping and ablation have important practical meanings.