Ohkubo Kimie, Watanabe Ichiro, Yamada Takeshi, Okumura Yasuo, Hashimoto Kenichi, Ashino Sonoko, Kofune Masayoshi, Kofune Tatsuya, Shindo Atsushi, Sugimura Hidezou, Nakai Toshiko, Kunimoto Satoshi, Hirayama Atsushi
Division of Cardiology, Department of Cardiovascular Disease, Nihon University School of Medicine, Tokyo, Japan.
Circ J. 2008 Oct;72(10):1650-7. doi: 10.1253/circj.cj-08-0099. Epub 2008 Sep 1.
It was hypothesized that atrial premature contractions (APCs) originating in the pulmonary veins (PVs) or superior vena cava (SVC) can be localized by evaluating characteristics of the P wave.
Thirty-eight patients with paroxysmal atrial fibrillation were studied. P wave polarity and morphology of the ECGs during pacing from PVs were analyzed and compared to those of APCs originating from PVs. The P wave angle and notch in lead II during pacing from the right superior (RS) PV and SVC was compared to those of spontaneous APCs originating from those veins. A positive P wave in lead I was helpful in predicting right PV origin. A positive P wave in lead II distinguished superior PV origin. A notched P wave was helpful in predicting left PV origin. P wave polarity in lead II was positive during RSPV and SVC pacing. P waves in lead II during RSPV pacing had notching in 80%, but all P waves were smooth during SVC pacing. A P wave angle of > 40 degrees and notching in lead II showed RSPV origin.
These criteria are helpful in selecting which of the 4 PVs should be isolated when APCs cannot be recorded after transseptal puncture.
据推测，起源于肺静脉（PVs）或上腔静脉（SVC）的房性早搏（APCs）可通过评估P波特征来定位。
对38例阵发性房颤患者进行了研究。分析了肺静脉起搏时心电图的P波极性和形态，并与起源于肺静脉的房性早搏的P波极性和形态进行比较。比较了右上（RS）肺静脉和上腔静脉起搏时II导联的P波角度和切迹与起源于这些静脉的自发性房性早搏的P波角度和切迹。I导联P波正向有助于预测右肺静脉起源。II导联P波正向可区分上肺静脉起源。切迹P波有助于预测左肺静脉起源。右上肺静脉和上腔静脉起搏时II导联P波极性为正向。右上肺静脉起搏时II导联P波80%有切迹，但上腔静脉起搏时所有P波均光滑。II导联P波角度>40度且有切迹提示右上肺静脉起源。
当经房间隔穿刺后无法记录到房性早搏时，这些标准有助于选择应隔离4条肺静脉中的哪一条。
