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目的分析上腔静脉起源房性早搏、心房纤颤(房颤)的体表心电图及心内电生理特点,探讨上腔静脉起源房颤的电生理机制。方法回顾2006年9月至2010年8月收治的12例经电生理证实上腔静脉起源阵发性房颤患者,男/女=9/3,平均年龄(55.3±12.2)岁,分析诱发房颤的房性早搏及房颤的心电图特征,以及CARTO指导下隔离上腔静脉所需操作时间、消融点数、并发症和手术成功率。结果与窦性P波相比,上腔静脉起源房早P波在Ⅱ导联幅度更高[(0.23±0.05)mVvs(0.15±0.05)mV,P<0.05],在V1导联呈现正负双向的比例更高(91.6%vs 33.3%,P<0.05),房颤波形态与房早及窦性P波相似(66.6%,8/12)。与隔离左上肺静脉相比,隔离上腔静脉所需操作时间[(18±11)min vs(33±16)min,P<0.05]、消融点数(14±6vs 36±11,P<0.05)明显减少,上腔静脉隔离后腔内电位仍显示快速激动8例,术后1个月内有2例患者出现阵发房扑,经药物控制后好转,所有患者均无并发症。结论上腔静脉起源房早及房颤具有独特的体表心电图特点,有助于术前预测靶静脉,上腔静脉电隔离所需时间及消融点数少,成功率高。
OBJECTIVE: To analyze the electrophysiological characteristics of atrial fibrillation (AF) induced by superior vena cava and the electrophysiological characteristics of the heart in order to explore the electrophysiological mechanism of atrial fibrillation originating from superior vena cava. Methods From September 2006 to August 2010, 12 cases of paroxysmal atrial fibrillation originated from superior vena cava were retrospectively analyzed. The average age was 55.3 ± 12.2 years (male / female = 9/3) Tremor of atrial premature beats and atrial fibrillation ECG characteristics, as well as CARTO under the guidance of the isolation of the superior vena cava required operation time, ablation points, complications and surgical success rate. Results Compared with sinus P wave, the P wave of atrial parenchyma originated from superior vena cava had a higher amplitude in Ⅱ lead ([(0.23 ± 0.05) mV vs (0.15 ± 0.05) mV, P <0.05] (91.6% vs 33.3%, P <0.05). The morphology of atrial fibrillation was similar to that of atrial premature sinus and sinus P wave (66.6%, 8/12). Compared with isolating the left superior pulmonary vein, the time required for isolation of the superior vena cava (18 ± 11) min vs (33 ± 16) min, P <0.05] and ablation points (14 ± 6 vs 36 ± 11, P <0.05) After the isolation of the superior vena cava, the intracavitary potential still showed rapid excitement in 8 patients. Within 2 months after operation, 2 patients developed paroxysmal atrial flutter. After the drug was controlled, the intracavitary potential improved and all patients had no complications. Conclusion The origin of atrial superior vena cava and atrial fibrillation have unique surface electrocardiogram characteristics, which is helpful for preoperative prediction of the target vein. The time required for electrical isolation of the superior vena cava and the number of ablation points are small, and the success rate is high.