无冠窦起源房性心动过速的电生理特点及射频消融治疗五例分析

目的研究无冠窦起源房性心动过速(房速)的电生理特点。方法 5例无冠窦起源房速患者,其中男性2例,女性3例,年龄37～68岁。观察心动过速时P波形态,心内标测心房最早激动部位,并行射频消融治疗。结果 5例无冠窦起源房速的周长平均为(363±44)ms。P波形态主要表现为在Ⅱ、Ⅲ和aVF导联上直立和双向,aVR导联倒置,在aVL导联上全为正向。胸前导联中,V_1～V_2为负正双向,V_3～V_5为负正双向或正向,V_6为正向。5例患者均于无冠窦内成功消融,术后随访6个月均未见复发。结论无冠窦起源房速P波形态的特征可能为右胸导联先负后正,下壁导联直立或双向。此类房速的射频消融安全有效。

Electrophysiologic characteristics and radiofrequency ablation of focal atrial tachycardia arising from non coronary sinus of valsalva in the aorta:5 case of analysis

Objective To investigate the eleetrophysiologic characteristics and radlofrequeney ablation of focal atrial tachyeardia（AT） arising from non coronary sinus. Methods Five consecutive patients （3 female and 2 male; age： 37-68 years） with AT arising from non coronary sinus were enrolled. The morphology of P waves was described as positive, negative, isoelectric or biphasic （positive-negative or negative-positive ）. The atrial mapping was performed during tachycardia to define the earliest atrial activation site. Results Mean tachycardia cycle length of AT in 5 patients was （363 ±44） ms. P wave morphology was predominantly upright or biphasic in lead Ⅱ , Ⅲ and aVF, inverted in aVR. Positive in aVL in all five patients. P waves in precordial leads were negative-positive in V1 and V2 , negative-positive or positive in lead V3-V5 , positive in lead V6. All the 5 patients underwent successful radiofrequency ablation within non coronary sinus. Conclusions The P wave morphology of AT arising from non coronary sinus is marked by initially negative with a late positive component in right precordial leads, upright or biphasic in inferior leads. Mapping and ablation of focal AT arising from non coronary cusp is safe and effective.