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目的探讨上腔静脉起源的心房颤动(房颤)的临床及电生理特点。方法回顾过去2年来我中心经电生理证实的起源于上腔静脉的房颤病例,分析其体表心电图及心腔内电生理特点。结果期间共16例患者(男/女=12例/4例,平均年龄53·4±10·6岁,阵发性/持续性房颤=11例/5例)经电生理证实房颤起源于上腔静脉,占同期接受导管消融病例的2·9%(16/545)。16例患者中,仅2例可以根据体表心电图诊断房颤为上腔静脉起源,此2例在上腔静脉隔离后房颤终止。另外14例体表心电图不典型者,先行左心房消融后,继续右心房标测过程中见上腔静脉驱动,隔离上腔静脉后房颤终止、不被诱发。隔离上腔静脉的平均放电次数6±2次,平均操作时间10±3min。上腔静脉-右心房之间肌束连接平均为3±1束。随访期间仅1例于术后3个月时出现心房扑动样发作。术后除1例出现右侧股静脉穿刺点血肿外,无其他并发症。结论上腔静脉可为肺静脉、左心房之外重要的房颤起源部位。对于心电图不典型者,完成左心房消融后如房颤不终止或易被诱发,则应考虑到上腔静脉起源的可能。
Objective To investigate the clinical and electrophysiological characteristics of atrial fibrillation (AF) originating from the superior vena cava. Methods The cases of atrial fibrillation originated from superior vena cava confirmed by electrocardiography in the past two years were retrospectively analyzed, and their body surface electrocardiogram and intracardiac electrophysiological characteristics were analyzed. A total of 16 patients (12 males / 12 females, average age 53.4 ± 10.6 years, paroxysmal / persistent atrial fibrillation = 11/5) were confirmed by electrophysiological evidence of the origin of atrial fibrillation In the superior vena cava, accounting for the same period received catheter ablation cases of 2.9% (16/545). Of the 16 patients, only two of the 16 patients were diagnosed with atrial fibrillation originating from the superior vena cava on the basis of the body surface electrocardiogram, and these two patients terminated AF after isolation of the superior vena cava. Another 14 cases of atypical surface ECG, first left atrial ablation, continue to the right atrium in the process of measuring the superior vena cava found in the isolation of the superior vena cava after termination of atrial fibrillation, is not induced. The average discharge times of superior vena cava 6 ± 2 times, the average operating time 10 ± 3min. The superior bundle vena cava between the right atrium was 3 ± 1 bundle. During follow-up, only 1 patient developed atrial flutter at 3 months after surgery. There was no other complication except one case of hematoma on the right femoral vein after operation. Conclusions The superior vena cava can be the important origin of atrial fibrillation outside the pulmonary veins and the left atrium. For atypical cases of ECG, after completion of left atrial ablation, such as atrial fibrillation is not terminated or easily induced, you should consider the possibility of origin of the superior vena cava.