Okuyama Yuji, Mizuno Hiroya, Oka Takafumi, Komatsu Sei, Hirayama Atsushi, Kodama Kazuhisa
Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
Heart Vessels. 2007 Jan;22(1):55-8. doi: 10.1007/s00380-006-0927-z. Epub 2007 Jan 26.
We report a patient with re-entrant atrial tachycardia that originated at the inferolateral tricuspid annulus. Single atrial extra-stimulation reproducibly induced the atrial tachycardia with an inverse relationship between the coupling interval of extra-stimulation and the return cycle of the first tachycardia beat. A real-time three-dimensional electroanatomical mapping showed focal atrial activation spreading semi-radially from the tricuspid annulus. The tachycardia was successfully eliminated by radiofrequency ablation at the earliest atrial activation site, preceding by 27 ms the arbitrary determined onset of surface P wave. An accelerated atrial rhythm with similar P-wave morphology to that of the tachycardia was observed at the successful ablation site during radiofrequency application. The mechanism of this tachycardia seems to be due to re-entry originating in or around the possible accessory atrioventricular node without ventricular connection.
我们报告一例起源于三尖瓣环下外侧的折返性房性心动过速患者。单次心房额外刺激可重复性地诱发房性心动过速，额外刺激的耦合间期与心动过速首个搏动的折返周期呈反比关系。实时三维电解剖标测显示局灶性心房激动从三尖瓣环呈半放射状扩散。在最早心房激动部位进行射频消融成功消除了心动过速，该部位比体表P波任意确定的起始点提前27毫秒。在射频消融过程中，在成功消融部位观察到一种房性节律加速，其P波形态与心动过速相似。这种心动过速的机制似乎是源于可能的无室连接的房室旁道内或其周围的折返。
