Miyazaki Shinsuke, Takigawa Masateru, Kusa Shigeki, Kuwahara Taishi, Taniguchi Hiroshi, Okubo Kenji, Nakamura Hiroaki, Hachiya Hitoshi, Hirao Kenzo, Takahashi Atsushi, Iesaka Yoshito
Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
Cardiovascular Center, Yokosuka Kyosai Hospital, Kanagawa, Japan.
J Cardiovasc Electrophysiol. 2014 Apr;25(4):380-386. doi: 10.1111/jce.12342. Epub 2014 Jan 6.
It is well known that superior vena cava (SVC) is one of the important non-pulmonary vein (PV) foci of atrial fibrillation (AF). However, little is known regarding the role of arrhythmogenic SVC in AF.
Among 1,425 patients who underwent AF ablation in 2 centers, PV antrum isolation was performed in all and SVC isolation was added in 74 (5.2%) patients with arrhythmogenic SVC (58 ± 10 years; 54 males) when the latter was identified as an AF source. The arrhythmogenicity was identified at the 1st, 2nd, and 3rd procedures in 62 (83.8%), 7 (9.5%), and 5 (6.7%) patients, respectively. In 7 (9.5%), 26 (35.1%), and 14 (18.9%) patients, it was identified following adenosine injection, isoproterenol infusion, and electrical cardioversion, respectively. SVC triggering AF was identified in 58 out of 74 (78.4%) patients. In this subset, AF initiated from SVC; however, AF cycle length was longer in SVC than in the right atrium once AF persisted, which suggested its role as an initiator. In 24 (32.4%) patients following the isolation of SVC, AF terminated or converted to atrial flutter and/or confined SVC tachycardia/fibrillation was observed, which suggested its role as a perpetuator. Sixty-four (86.5%) of 74 patients were free from any atrial tachyarrhythmias without antiarrhythmic drugs mean 12.1 ± 9.4 months after the last ablation procedure (mean 1.38 procedures/patient).
In a subset of patients, SVC plays a role in AF not only as an initiator/trigger but also as a driver/perpetuator.
众所周知，上腔静脉（SVC）是心房颤动（AF）重要的非肺静脉（PV）病灶之一。然而，关于致心律失常性上腔静脉在房颤中的作用，人们知之甚少。
在两个中心接受房颤消融的1425例患者中，所有患者均进行了肺静脉前庭隔离，74例（5.2%）致心律失常性上腔静脉患者（58±10岁；54例男性）在被确定为房颤起源时加做了上腔静脉隔离。分别在第1、2和3次手术中确定致心律失常性的患者有62例（83.8%）、7例（9.5%）和5例（6.7%）。分别在7例（9.5%）、26例（35.1%）和14例（18.9%）患者中，经腺苷注射、异丙肾上腺素输注和电复律后确定致心律失常性。74例患者中有58例（78.4%）确定为上腔静脉触发房颤。在这一子集中，房颤起源于上腔静脉；然而，一旦房颤持续，上腔静脉的房颤周期长度比右心房更长，这表明其作为启动子的作用。在24例（32.4%）上腔静脉隔离后的患者中，房颤终止或转变为心房扑动和/或观察到局限性上腔静脉心动过速/颤动，这表明其作为维持者的作用。74例患者中有64例（86.5%）在最后一次消融手术后平均12.1±9.4个月（平均每位患者1.38次手术）未使用抗心律失常药物的情况下无任何房性快速心律失常。
在一部分患者中，上腔静脉在房颤中不仅起启动子/触发因素的作用，还起驱动因素/维持者的作用。
