与肌袖电活动相关的短阵心房扑动的心电图和心内电生理研究

选择体表心电图表现为短阵心房扑动 (简称房扑 )的阵发性心房颤动 (简称房颤 )病例 ,结合心内电生理标测和导管射频消融大静脉肌袖电隔离的结果 ,探讨短阵房扑与心脏大静脉肌袖和房颤的关系。 2 3例阵发性房颤 ,心电图和动态心电图表现为短阵发作的房扑的患者入选本研究 ,2 3例中有 17例进行了心内电生理标测 ,有 14例标测到短阵房扑和房颤 ,其中单纯短阵房扑发作 8例 ,短阵房扑触发房颤 6例 ,均提示短阵房扑为起源于大静脉肌袖的快速电活动所驱动 ,其中肺静脉 10根 ,上腔静脉 4根 ,均进行了相关肌袖的导管射频消融电隔离治疗 ,成功 13例。结论 :短阵房扑的发生机理是大静脉肌袖的快速电活动所驱动 ,这种机制与阵发性房颤的发生有密切关系 ,短阵房扑可能是房颤由肌袖电活动触发的特征性心电图表现 ,导管射频消融电隔离是治疗这一心律失常的有效方法。

Paroxysmal Atrial Flutter :Specific Electrocardiogram Characteristics of Myocardial-Sleeve-Triggered Atrial Fibrillation

The aim of this study is to investigate the underlying mechanism of paroxysmal atrial flutter and its relationship with paroxysmal atrial fibrillation.Seventeen patients with paroxysmalatrial flutter and atrial fibrillation in surface ECG or Holter recordings were enrolled for electrophysiologic study and catheter ablation. Pulmonary veins (PVs) and superior vena cava (SVC) were mapped with circular mapping catheter during the attack. If the arrhythmogenic PV or SVC can be confirmed, the electrical isolations by radiofrequency ablation technique were preformed.Results: Paroxysmal atrial flutter was mapped in fourteen patients,which all showed the driving mechanism by PV ( in 10 cases ) or SVC( in 4 cases) electrical discharges.Atrial fibrillation initiated by the focal flutter were evidenced in 6 patients. Electrical isolations of targeted PV or SVC were successfuly achieved in 13/14 patients .Conclusion : The paroxysmal atrial flutter is related in mechanism to the electrical firing from myocardial sleeves. The flutter could be responsible for the initiation of atrial fibrillation in most cases. The electrical isolation of the arrhythmogenic sleeves by radiofrequency catheter ablation can be the first-line therapy in these patients.