阵发性室上性心动过速和阵发性心房颤动患者的电生理特征及导管消融
Electrophysiological characteristics and catheter ablation in patients with paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation.
作者信息
Chang Shih-Lin, Tai Ching-Tai, Lin Yenn-Jiang, Lo Li-Wei, Tuan Ta-Chuan, Udyavar Ameya R, Tsao Hsuan-Ming, Hsieh Ming-Hsiung, Hu Yu-Feng, Chiang Shuo-Ju, Chen Yi-Jen, Wongcharoen Wanwarang, Ueng Kwo-Chang, Chen Shih-Ann
机构信息
Division of Cardiology and Cardiovascular Research Center, School of Medicine, National Yang-Ming University, and Taipei Veterans General Hospital, Taipei, Taiwan.
出版信息
J Cardiovasc Electrophysiol. 2008 Apr;19(4):367-73. doi: 10.1111/j.1540-8167.2007.01065.x. Epub 2007 Dec 20.
INTRODUCTION
Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF.
METHODS AND RESULTS
Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 +/- 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 +/- 3 vs. 41 +/- 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2.
CONCLUSION
The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome.
引言
阵发性室上性心动过速（PSVT）常与阵发性心房颤动（AF）相关。然而，PSVT与AF之间的关系仍不明确。本研究旨在探讨PSVT合并AF患者的临床和电生理特征，并在AF射频消融术前明确AF的起源。
方法与结果
纳入402例连续接受射频消融的阵发性AF患者（338例为单纯肺静脉病灶，64例为非肺静脉病灶）。21例同时患有PSVT和AF的患者（10例女性；平均年龄47±18岁）被分为两组。第1组由14例可诱发房室结折返性心动过速（AVNRT）和AF的患者组成。第2组由7例预激综合征（WPW）合并AF的患者组成。AF非肺静脉病灶患者的AVNRT发生率高于肺静脉病灶患者（11%对2%，P = 0.003）。AF合并非典型AVNRT患者的上腔静脉（SVC）AF异位发生率高于AF合并典型AVNRT患者（86%对14%，P = 0.03）。第1组患者的左心房（LA）直径较小（36±3对41±3mm，P = 0.004），AF起源于SVC的发生率高于第2组（50%对0%，P = 0.047）。
结论
SVC AF与AVNRT关系密切。AVNRT和WPW综合征之间心房易损性和重构的影响可能不同。
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