Kaneko Yoshiaki, Kato 'Ritsushi, Nakahara Shiro, Tobiume Takeshi, Morishima Itsuro, Tanaka Kazuhiko, Nakajima Tadashi, Irie Tadanobu, Kusano Kengo Fukushima, Kamakura Shiro, Nagase Takahiko, Takayanagi Kan, Matsumoto Kazuo, Kurabayashi Masahiko
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Heart Lung Circ. 2015 Oct;24(10):988-95. doi: 10.1016/j.hlc.2015.03.009. Epub 2015 Mar 24.
Ablation of focal atrial tachycardia (AT) originating from the interatrial septum (IAS) is challenging because of its complex anatomy.
We studied the electrocardiographic and electrophysiologic characteristics of focal, septal AT in seven patients who underwent successful ablation.
The site of successful ablation was at the site of earliest activation on the right side of the IAS in three patients and on the left side in four patients, >1cm away from the centre of the fossa ovalis in the septum secundum. A negative or +/- versus a positive or -/+ P wave in lead V1 during AT accurately predicted a right- versus left-sided origin of the AT, respectively. In the four left septal AT cases, right atrial activation mapping opposite the site of successful ablation revealed the presence of a small, low-frequency potential followed by a larger, high-frequency potential. In contrast, a high-frequency potential was not preceded by a low-frequency potential in the three right septal AT cases.
Septal AT may originate from either side of the septum secundum. The P wave polarity in lead V1 accurately predicted the side of the IAS that the AT originated from. Left septal AT is characterised by the recording of double potentials reflecting far-field activation of the left-sided IAS, followed by near-field activation of the right-sided IAS, when recording from its right side, opposite the AT origin. These observations are particularly relevant when mapping an apparent right septal AT.
由于解剖结构复杂，起源于房间隔（IAS）的局灶性房性心动过速（AT）消融具有挑战性。
我们研究了7例成功接受消融的局灶性、间隔性AT患者的心电图和电生理特征。
3例患者成功消融部位位于IAS右侧最早激动部位，4例位于左侧，距继发隔卵圆窝中心>1cm。AT期间V1导联负向或±与正向或-/+ P波分别准确预测了AT起源于右侧或左侧。在4例左间隔AT病例中，在成功消融部位对侧进行右心房激动标测显示存在一个小的低频电位，随后是一个较大的高频电位。相比之下，3例右间隔AT病例中高频电位之前没有低频电位。
间隔性AT可能起源于继发隔的两侧。V1导联P波极性准确预测了AT起源的IAS侧。左间隔AT的特征是，当从AT起源部位对侧的右侧进行记录时，记录到反映左侧IAS远场激动的双电位，随后是右侧IAS的近场激动。在标测明显的右间隔AT时，这些观察结果尤为重要。
