阵发性心房颤动患者心脏大静脉肌袖电活动特征的临床研究

总结和探讨阵发性心房颤动(简称房颤)患者心内电生理标测中肺静脉和上腔静脉内肌袖电活动的特征,及其与房颤的关系。选择无器质性心脏病的顽固性阵发性房颤患者 126例,用环状标测电极行肺静脉和 /或上腔静脉电生理标测,分析引起房性心律失常时肌袖内的电活动类型、频率、发作方式及其与房颤之间的联系。结果:有50例(39. 7% )经心电生理标测证实其房性心律失常与大静脉肌袖的自发电活动相关。共标测心脏大静脉 354根,心律失常相关大静脉 59根,包括肺静脉 49根、上腔静脉 10根。电活动类型呈现单一或连发电活动 38根,呈短阵性快速电活动 8根,呈连续快速( >300次 /分)电活动 27根,呈连续较慢电活动 ( <100次 /分 ) 2根。房颤的发生均与静脉肌袖内连续快速的、规律或紊乱的电活动对心房的引发有关。结论:根据房性心律失常发作时的大静脉肌袖内电位的特征以及与心房电位的关系,可以明确判定房颤的相关肌袖。同一根大静脉肌袖可表现为 2种或 2种以上的电活动类型,其中以单一和连续快速电活动多见,房颤均为静脉肌袖内的连续快速电活动所引发,而非单一房性早搏诱发。

Clinical Investigation on Spontaneous Electrical Activity of the Cardiac Veins in Patients With Paroxysmal Atrial Fibrillation

The purpose of this study is to describe the features of spontaneous electrical discharges in pulmonary veins (PV) and superior vene cava (SVC) in patients with paroxysmal atrial fibrillation(PAF). 126 patients with refractory PAF underwent the electrophysiological study (EPS). With lasso mapping catheter in each vein during the episode of atrial tachyarrhythmias, both the potentials in the vein and the atria were simultaneously recorded. Their characteristics and the relationship between the atria potentials and the myocardial sleeves potentials were analyzed. Results: Spontaneous electrical discharges triggering or initiating atrial arrhythmias were recorded in 59 veins of 50 patients(39.7%),including 49 PVs and 10 SVCs. There were one or more patterns of discharges inside each arrhythmogenic vein, including frequent or bigeminal discharges in 38, short runs (in salvos) of discharges in 8 and continuous firing in 27. The total 23 onsets of PAF were documented,which were always preceded by short and fast atrial tachycardia or flutter-like activities driven by continuous electrical firing from veins with variable degrees of exit block. Conclusions:The target veins as arrhythmogenic triggers can be confirmed by mapping the cardiac veins with circular mapping catheter during the onsets of atrial tachyarrhythmias. The pattern of spontaneous electrical activities within the veins could be occasional one or two discharges, repetitive runs or continuous firing. The PAF in our cases are proven to be actually initiated by atrial tachycardia or flutter driven by continuous electrical firing rather than only early premature beats driven by one discharge from the PV or SVC.