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。

Electrocardiographic characteristics and radiofrequency catheter ablation of atrial tachycardia originating from the nonseptal region of the tricuspid annulus.

Objective To delineate the electrocardiographic features and results of radiofrequency catheter ablation （RFCA） of atrial tachycardia （AT） originating from the nonseptal region of tricuspid annulus （TA）. Methods The study included 13 patients with ATs originating from the nonseptal region of TA that were successfully ablated by RFCA. The location of the AV annuli was confirmed by using the AV ratio of the local electrograms （ A： V 〈 2 ） and the amplitude of the ventricular electrograms（ 〉 0.5 mV） in addition to the anatomic findings under fluoroscopic guidance. Results The annular focus was localized to the inferior TA in 9 cases and the superior TA in 4 cases. The target atrial electrogram precedes the onset of P wave in surface electrocardiogram by 41 ± 15 ms. The AV ratio of the local electrograms was 0.5 ±0.4. In the inferior TA, the P wave morphology was positive in Ⅰ , aVL,aVR,but was inverted in inferior and V1-V6 leads. In the superior TA, the P wave morphology was positive in I, aVL, negative or isoelectric in aVR, low amplitude positive or isoelectric in inferior leads, negative in lead V1 , and progressively positive across the precordial leads. Conclusion The non- septal region of TA is an important site of right AT origin with characteristic P wave morphology. Chinese Journal of Cardiac Pacing and Electrophysiology,2009,23 （ 1 ） ：37 - 39 ]