摘要
目的介绍具有良好变时作用的房性异位心律(C-EAR)这一特殊类型的心律失常,分析其临床特征、可能的电生理机制及导管消融方法。方法共4例患者(男性3例),临床拟诊房性心动过速(房速)收住院,基础节律均为异位房性心律。其中1例既往有房间隔缺损修补术病史,余均无器质性心脏病史。常规穿刺置入导管行心内电生理检查,术中记录基础节律、最快节律及心动过速的心内电图。是否射频消融根据电生理检查的结果。所有患者术前、术后均行动态心电图检查。结果4例患者C-EAR分别位于右后间隔、右中间隔、三尖瓣环9点钟和左下肺静脉开口处。C-EAR基础状态平均房率为(84±19)次/min;临床或术中发现的最快房率平均为(198±20)次/min。病例1和病例2术中诱发出和基础节律不同源的房速,其中病例1合并围绕右心房侧壁手术疤痕折返的房速,消融未成功;病例2合并希氏束旁房速,消融成功。病例1和病例2的基础C-EAR未作消融。病例3和病例4的房速与C-EAR同源,病例3消融失败,病例4消融成功转为稳定窦性心律。4例患者的动态心电图显示,C-EAR随昼夜节律波动,根据生理需要升降,体现出良好的变时性作用。平均最慢房率(68±20)次/min,平均最快房率为(134±17)次/min,日平均房率的平均值为(96±13)次/min。结论C-EAR是一种特殊节律,它是由异位起搏细胞的自律性增加所致。如在此基础上合并触发活动或局部微折返则可形成同源的心动过速。由于C-EAR具有良好的变时性作用,在不合并同源性心动过速时,无需消融治疗。
Objective Sustained ectopic atrial rhythm with sufficient chronotropic function （C-EAR） is an arrhythmia of special entity, but little is known about it. In this study,we will introduce the clinical characteristics and catheter ablation method of C-EAR and discuss its probable electrophysiological （EP） mecha- nisms. Methods Four consecutive patients （3 male, age from 10 to 40 years old） with atrial tachycardia （AT） were included in the study. The ECG of all these patients during baseline showed sustained ectopic atrial rhythm. One patient had the history of surgical repairment of atrial septal defect, the rest 3 had no structural heart disease. EP study and Hoher mornitoring were done in all patients. Results Four C-EARs were found to be originated from right middle atrial septum, right posterior atrial septum, 9 o＇clock of tricuspid anulus and the ostia of left inferior pulmonary vein, respectively. The mean heart rate of C-EAR during baseline and the fastest rhythm were 84±19 and 198±20 bpm, respectively. The AT was induced and found to be different origin from EAR in patient 1 and 2, so catheter ablation of C-EAR was not tried. AT and C-EAR was showed in the same origin in patient 3 and 4, and radiofrequency ablation was attempted but failed in patient 3. Sinus rhythm was recovered in patient 4 after ablation. Hoher mornitoring of all patients showed a very good chronotropie competence of ectopic atrial rhythm. The mean slowest, fastest and mean heart rate of Hoher was 68±20, 134±17 and 96±13 bpm, respectively. Conclusions The increased automaticity of the pacemaker cells which were widely distributed in both atria is the basic mechanism of C-EAR. C-EAR can be accompanied by AT of the same origin because of triggered activity and/or microreentry of the pacemaker cells. The C-EAR is a benign arrhythmia due to its sufficient chronotropic function, so catheter ablation is not necessary if without AT of the same origin.
出处
《中华心律失常学杂志》
2006年第1期9-13,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
房性异位心律
变时性
射频导管消融
Ectopic atrial rhythm
Chronotropic
Radiofrequency catheter ablation
