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起源于肺静脉的房性心律失常体表心电图和心内电生理特点

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第6期
页码:
887-890
栏目:
临床研究
出版日期:
2010-08-23

文章信息/Info

Title:
Electrophysiological features of tachycardia atrial arrhythmia originating from pulmonary veins in patients with or without atrial fibrillation
作者:
许燕平1; 张树龙2; 韩琳琳3; 黄立萍2; 丛培鑫2; 丁元芳1; 刘小辉1
大连市友谊医院:1.心内科,3.超声科，辽宁 大连 116001；2.大连医科大学第一附属医院心内科,辽宁 大连 116011
Author(s):
XU Yan-ping1;  ZHANG Shu-long3;  HAN Lin-lin2;  HUANG Li-ping3;  CONG Pei-xin3;  DING Yuan-fang1;  LIU Xiao-hui1
1.Department of Cardiology, Dalian Friendship Hospital, Dalian 116001, Liaoning, China; 2.Department of Ultrasound, Friendship Hospital of Dalian, Dalian 116001, Liaoning, China; 3.Department of Cardiology, First Affiliated Hospital, Dalian Medical University, Dalian 116011, Liaoning, China
关键词:
肺静脉; 心律失常; 房性; 体表心电图; 心内电生理
Keywords:
pulmonary vein;  atrial arrhythmia;  body surface electrocardiogram;  electrophysiology
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的: 分析起源于肺静脉的房性心律失常体表心电图和心内电生理特点，识别触发心房纤颤（房颤）的房性期前收缩（房早）和房性心动过速（房速）。 方法： 回顾性分析房性心律失常并阵发性房颤84例体表心电图（房颤组），非房颤组84例体表心电图为频发房早（>800次/24 h）。房颤组结合心内电生理检查及Lasso环状电极标测，行导管射频消融（RFCA）肺静脉隔离（PVI）。结果： 房颤组电隔离肺静脉286支，均达即刻成功标准，无并发症发生。房颤组体表心电图呈房早、房速、心房扑动（房扑）和阵发性房颤（房颤）频繁发作和交替转换，并常伴长间歇，房早联律间期470～280（420±57）ms明显短于非房颤组的房早联律间期660～350（610±86）ms，P<0.05,房颤多由短联律间期房早触发。心内电生理改变为Lasso环状电极标测到起源于肺静脉的连续、快速、有序或无序的较P波提前,时限短、峰锐利的尖峰电位（Spike电位），同步心电图显示该Spike电位常是阵发性房颤的触发因素。经导管射频消融消除肺静脉内电位或隔离肺静脉与心房间的电或组织连接，可终止房性心律失常，维持窦性心律。 结论： 起源于肺静脉的房性心律失常的特点是短联律间期房早，也是阵发性房颤的触发因素。
Abstract:
AIM: To analyze characteristics of atrial arrhythmia originating from pulmonary veins and to discriminate atrial arrhythmia that can induce atrial fibrillation (AF) in patients with or without AF. METHODS: Eighty-four patients with AF (AF group) and 84 patients without paroxysmal atrial premature beats, atrial tachycardia, and atrial flutter were analyzed in two groups. Pulmonary vein isolation is the end point. RESULTS: Two hundred eighty-six pulmonary veins were isolated without complications. Coupled interval of atrial premature beats shortened more significantly in the AF group than in control group (P<0.05). Atrial tachycardia rate increased more significantly in the AF group than in control group (P<0.05). Atrial flutter is more common in the AF group than in control group. CONCLUSION: A characteristic of atrial arrhythmia originating from pulmonary veins is the shorter interval of atrial premature beats that is always a cause of paroxysmal atrial fibrillation.

参考文献/References

［1］杨延宗,刘少稳. 心房颤动与导管射频消融心脏大静脉电隔离术［M］. 北京: 科学出版社, 2004:2-110.

［2］Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrail fibrillation by ectopic beats originating in the pulmonary veins［J］. N Engl Med, 1998, 339(10):659-666.

［3］Pappone C, Augello G, Sala S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study［J］. J Am Coll Cardiol, 2006, 48(11):2340-2347.

［4］Arruda M, Natale A. Ablation of permanent AF : Adjunctive strategies to pulmonary veins isolation: Targeting AF NEST in sinus rhythm and CFAE in AF［J］. J Interv Card Electrophysiol, 2008, 23(1):51-57.

［5］洪丽，杨延宗. 起源于胸腔内大静脉的房性异位搏动体表心电图特征［J］. 中华心律失常学杂志, 2006, 10(4):316.

［6］杨延宗，马长生，张澍,等. 心房颤动的肺静脉和腔静脉电隔离治疗—目前的认识和建议［J］. 中华心律失常学杂志, 2004, 8(1):5-9.

[7]罗兰,周从义. 肌袖性心房扑动［J］. 实用心电学杂志, 2004, 13(1):78-79.

[8] Rostock T, Steven D, Lutomsky B, et al. Atrial Fibrillation Begest Atrial Fibrillation in the Pulmonary Veins: On the Impact of Atrial Fibrillation on the Electrophysiological Propties of Pulmonary Veins in Humans［J］. J Am Coll Cardiol, 2008, 51(22):2152-2161.

备注/Memo

备注/Memo:
收稿日期：2009-07-14.作者简介：许燕平，主治医师Emiail:Xuyanping1955815@qq.com
更新日期/Last Update: 2010-08-22