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目的 分析上腔静脉 (SVC)起源的异位冲动诱发阵发性心房颤动 (PAF)的特点 ,总结射频导管消融电隔离SVC治疗PAF的经验。方法 在连续收治的 130例射频导管消融电隔离心脏大静脉治疗PAF的患者中 ,11例患者的PAF由SVC起源的异位冲动所诱发 (8 5 % ) ,其中 2例因合并慢 快综合征而植入心脏起搏器。结果 房性早搏 (房早 )和房性心动过速 (房速 )时 ,P′波在Ⅱ、Ⅲ、aVF导联直立 ,振幅高于窦性P波 ;在aVL和V1导联与窦性P波相比 ,正向波幅度降低、负向波加深。心内电生理检查发现 ,房早时SVC电位跃至心房电位之前 ,早于体表P′波和心房内其他部位电活动 ,并可诱发房颤 ;有时心房内呈规律的快速电活动 ,而SVC内为频率更快的电活动 ,或者两者之间呈 1∶1的关系 ,但SVC电位早于心房内任何部位 ,提示SVC为诱发房颤的靶静脉。所有患者均成功电隔离了SVC ,术后即刻 4名患者SVC内仍有自发快速电活动 ,6名患者SVC内有自发慢频率电活动 ,但心房内为稳定的窦性心律。随访 3～ 2 4个月 ,2例患者PAF复发 ,再次消融后症状消除 ,多次复查动态心电图 ,无PAF的证据。结论 起源于SVC的异位冲动也可诱发PAF ,SVC起源的房早和房速体表心电图P′波有一定特征。射频导管消融可以成功电隔离SVC ,预防PAF的复发。在部分诊断为慢 快
Objective To analyze the characteristics of paroxysmal atrial fibrillation (PAF) induced by ectopic impulses originating from superior vena cava (SVC) and to summarize the experience of radiofrequency catheter ablation (SVC) in the treatment of PAF. Methods PAFs were induced by 130 patients with PAF treated by radiofrequency catheter ablation and continuous cardiac catheterization. PAFs were induced by ectopic impulses of SVC origins in 11 patients (85%), and 2 of them were complicated by slow syndrome The implantation of pacemakers. Results In the atrial premature beats and the atrial tachycardia, the P wave was upright in Ⅱ, Ⅲ and aVF leads and the amplitude was higher than that of sinus P wave. In the aVL and V1 leads and sinus Compared with P wave, the amplitude of forward wave decreases and the negative wave deepens. Cardiac electrophysiological examination found that as early as the SVC jump to the atrial potential before, earlier than the body surface P ’wave and other parts of the atrial electrical activity and can induce atrial fibrillation; sometimes atrial rapid regular electrical activity, and SVC for the frequency of faster electrical activity, or a 1: 1 relationship between the two, but SVC potential earlier than any part of the atrium, suggesting that SVC is the target vein for the induction of atrial fibrillation. In all patients, SVC was successfully electrically isolated. There were still spontaneous and rapid electrical activities in SVC in 4 patients immediately after surgery. Six patients had spontaneous and slow frequency electrical activity in SVC, but stable sinus rhythm in the atria. After 3 to 24 months of follow-up, PAF recurred in 2 patients, eliminated symptoms after ablation, and repeatedly reviewed ambulatory electrocardiogram without evidence of PAF. Conclusions Ectopic impulses originated from SVC may also induce PAF. The characteristics of SVP originating AP and P ’Atrial electrocardiogram P’ wave have some characteristics. Radiofrequency catheter ablation can successfully electrically isolate SVC and prevent the recurrence of PAF. In the part diagnosed as slow