Freixa Xavier, Berruezo Antonio, Mont Lluís, Magnani Santiago, Benito Begoña, Tolosana Jose María, Perafan Pablo, Tamborero David, Brugada Josep
Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain.
Europace. 2008 Jan;10(1):105-9. doi: 10.1093/europace/eum264. Epub 2007 Dec 12.
Though right atrial appendage tachycardia (RAAT) has been described, no studies to date have focused on its clinical characterization. The aim of the present study was to analyze its clinical, electrocardiographic (ECG), and electrophysiologic (EP) characteristics and the results of radiofrequency ablation (RFA) in RAAT.
Out of 186 consecutive patients undergoing RFA for AT, 15 (8%) had focal RAAT. Mapping was performed using conventional catheters or a 3D electroanatomic mapping system. Patients with RAAT were more likely to be male (66 vs. 38%; P= 0.013) and younger (32 +/- 12.6 vs. 55 +/- 13.2 years; P < 0.001) than patients with AT originating elsewhere. They were also more likely to have dyspnea (27 vs. 7.6%; P = 0.03), incessant tachycardia (53 vs. 16%; P < 0.001), and left ventricular systolic dysfunction (27 vs. 5%; P = 0.018). RFA was effective in all patients (100 vs. 75%; P = 0.022) and no recurrences (0 vs. 8%; P = 0.31) were observed during a mean follow-up of 37 +/- 36 months. A specific ECG pattern was identified, consisting of negative P-waves in leads V1-V2 and a transition to positivity in the rest of the precordial leads. This ECG pattern correctly identified RAAT with a sensitivity of 100%, a specificity of 98%, a positive predictive value of 88%, and a negative predictive value of 100%.
Right atrial appendage tachycardia is more prevalent in young male patients and is commonly associated with tachycardiomyopathy. RFA is effective over long-term follow-up. A characteristic ECG pattern identifies RAAT with a very high sensitivity and specificity.
虽然右心耳心动过速（RAAT）已被描述，但迄今为止尚无研究聚焦于其临床特征。本研究的目的是分析RAAT的临床、心电图（ECG）和电生理（EP）特征以及射频消融（RFA）的结果。
在连续接受RFA治疗房性心动过速（AT）的186例患者中，15例（8%）为局灶性RAAT。使用传统导管或三维电解剖标测系统进行标测。与起源于其他部位的AT患者相比，RAAT患者更可能为男性（66%对38%；P = 0.013）且更年轻（32±12.6岁对55±13.2岁；P < 0.001）。他们也更可能出现呼吸困难（27%对7.6%；P = 0.03）、持续性心动过速（53%对16%；P < 0.001）和左心室收缩功能障碍（27%对5%；P = 0.018）。RFA对所有患者均有效（100%对75%；P = 0.022），在平均37±36个月的随访期间未观察到复发（0%对8%；P = 0.31）。识别出一种特定的ECG模式，包括V1 - V2导联P波为负，胸前区其余导联P波转为正向。这种ECG模式识别RAAT的敏感性为100%，特异性为98%，阳性预测值为88%，阴性预测值为100%。
右心耳心动过速在年轻男性患者中更为常见，且常与心动过速性心肌病相关。RFA在长期随访中有效。一种特征性的ECG模式以非常高的敏感性和特异性识别RAAT。
