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
Electrophysiological features of tachycardia atrial arrhythmia originating from pulmonary veins in patients with or without atrial fibrillation
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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.
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