Hiramatsu Shigeki, Tada Hiroshi, Sakamoto Yuichiro, Kaseno Kenichi, Sato Chizuru, Irie Tadanobu, Yokokawa Miki, Nagase Satoshi, Naito Shigeto, Kusano Kengo Fukushima, Yamagishi Masakazu, Ohe Tohru, Aonuma Kazutaka, Oshima Shigeru, Taniguchi Koichi
Department of Cardiovascular Medicine, Okayama University Graduated School of Medicine, Density and Pharmaceutical Science, Japan.
Circ J. 2009 May;73(5):838-45. doi: 10.1253/circj.cj-08-0866. Epub 2009 Mar 31.
Some supraventricular tachycardias could be ablated from the non-coronary sinus of Valsalva (NSV). However, the characteristics of the NSV electrograms have not been clarified.
A quantitative analysis of the NSV electrograms was performed in 5 patients with tachycardias arising from near the atrioventricular node (AVN) and the His-bundle region, and in 20 control subjects. In another 7 control subjects, the NSV electrograms were compared with those recorded at the left and right sinus of Valsalva (LSV and RSV). The NSV electrograms during sinus rhythm had a larger atrial amplitude than ventricular amplitude, and the ratio of the atrial amplitude to the ventricular amplitude was usually >1, which was apparently different from the LSV and RSV electrograms. A tiny but distinct His-bundle deflection was sometimes recorded at the NSV during sinus rhythm while it was not during the tachycardia. The distance to the His-bundle region in the anteroseptal right atrium was shorter from the NSV than from the RSV or LSV.
The precise identification of the catheter position at the NSV is possible using the characteristics of the electrograms. Much attention should be paid during ablation to the NSV because of its vicinity to the AVN and His-bundle region.
一些室上性心动过速可从主动脉窦无冠窦（NSV）进行消融。然而，NSV电图的特征尚未明确。
对5例起源于房室结（AVN）和希氏束区域附近的心动过速患者以及20名对照者的NSV电图进行了定量分析。在另外7名对照者中，将NSV电图与在主动脉窦左窦和右窦（LSV和RSV）记录的电图进行了比较。窦性心律时NSV电图的心房波幅大于心室波幅，心房波幅与心室波幅之比通常>1，这明显不同于LSV和RSV电图。窦性心律时有时在NSV可记录到微小但明显的希氏束偏转，而心动过速时则无。前间隔右心房中NSV到希氏束区域的距离比RSV或LSV更近。
利用电图特征可精确识别导管在NSV的位置。由于NSV靠近AVN和希氏束区域，消融时应予以高度关注。
