摘要
目的:探讨射频消融术治疗无冠窦房性心动过速(房速)的方法学特点。方法:分析14例无冠窦房速患者发作时体表心电图P波特点,展示发作时无冠窦、左房前间隔和希氏束最早激动的时间差异,5例患者采用三维(EnSite 3000NavX)建模标测。结果:房速发作时P波时限(83±4)ms明显短于窦性心律时P波时限(106±9)ms,P<0.05;右房最早激动点位于希氏束或其附近;无冠窦内最早心房激动较希氏束提前(10.8±7.2)ms,先于体表心电图P波提前(20.8±7.2)ms,5例患者通过房间隔穿刺术在左房前间隔测及的最早激动点较右房晚(4±2)ms。12例患者均在无冠窦内消融成功,2例患者在无冠窦内和希氏束后上方与无冠窦相对应处同时消融成功。随访4～30个月均无复发。结论:射频消融术是根治无冠窦房速的有效方法,对于房速消融不成功者,可选择在无冠窦内和希氏束后上方与无冠窦相对应处同时消融。
Objective：To demonstrate and investigate the electrophysiologic characteristics and radiofrequency ablation（RFCA） of focal atrial tachycardia（AT） arising from non-coronary cusp（NCC）.Method：Fourteen patients（5 male,9 female,mean age years） with paroxysmal AT for（15±5） years were included.During tachycardia,P-wave morphology on 12-lead ECG in patients with NCC were described;the time difference of the site with earlist atrial activation among the NCC,His bundle（HB） region and the left atrial anteroseptum were displayed,In 5 patients,an activation map were created using 3-dimensional electroanatomical mapping system（EnSite 3000 NavX）;RFCA of AT arising from NCC were explored.Result：The P wave duration（83±4） ms during AT were significantly shorter than P wave duration（106±9） ms during sinus rhythm（P0.05）.The earliest atrial activation site was recorded in His-bundle or near it region in right atrium;mapping in the aortic noncoronary sinus cusp demonstrated that an earliest atrial activation preceded the atrial activation at HB by（10.8±7.2） ms,P-wave on 12-lead ECG by（20.8±7.2） ms,it was also measured on the left side of the atrial anteroseptum（4±2） ms later than the HB in 5 patients performed transseptal puncture approach.14 patients underwent successful RFCA,12 within NCC,but 2 in NCC and at supero-posterior to sites with HB in right atrium at the level of NCC by Radiofrequency energy delivered.All patients were free of the arrhythmias without antiarrhythmic drugs during a follow-up of 4-30 months.Conclusion：RFCA of AT arising from NCC is safe and effective.If not successful within NCC,it is another method that radiofrequency energy delivered in NCC and at supero-posterior to sites with HB in right atrium at the level of NCC.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2011年第11期814-818,共5页
Journal of Clinical Cardiology
关键词
心动过速
射频消融术
无冠窦
tachycardia
radiofrequency ablation
non-coronary cusp
