Division of Cardiology, Korea University College of Medicine, Seoul, Korea.
Korean Circ J. 2013 Jan;43(1):29-37. doi: 10.4070/kcj.2013.43.1.29. Epub 2013 Jan 31.
The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF).
A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated.
Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications.
The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation.
窦房静脉（SV）并非房性心动过速（AT）的常见起源部位，但在房颤（AF）的导管消融过程中，SV 可能会引起 AT。
共回顾了 1223 例接受 AF 导管消融的患者。研究了源自 SV 的 AT 导管消融的电生理和心电图特征及结果。
10 例患者（0.82%）在 AF 消融过程中出现源自 SV 的 AT（7 例男性，53.9±16.0 岁，6 例持续性）。平均心动周期长度为 281±73ms。在肺静脉隔离和左心房消融后，2 例患者在右心房消融时 AF 转为源自 SV 的 AT，7 例患者在 AF 终止后快速心房起搏，1 例患者在异丙肾上腺素输注时转为源自 SV 的 AT。大多数患者（90%）显示下壁导联的正向 P 波。AT 的激动顺序是从上腔静脉的近端到远端，在右心房是从高到低，与源自冠状窦末端的 AT 相似。窦性期间记录到碎裂的双电位，在 AT 期间，第二个离散电位比 P 波提前 80±37ms。使用 4.4±2.7 个射频局灶应用，终止了 AT 并使其不再可诱发。消融术后，2 例患者出现短暂性右侧膈神经麻痹。19.9±14.8 个月后，除 1 例外，所有患者均无房性心动过速且无并发症。
在 AF 消融过程中发生的 AT 很少源自 SV，其电生理特征有助于指导有效的局灶消融。
