Sugimura Sousuke, Kurita Takashi, Kaitani Kazuaki, Yasuoka Ryobun, Miyazaki Shunichi
Division of Cardiology, Department of Medicine, Faculty of Medicine, Kinki University, 377-2 Onohigashi, Osaka-Sayama, 589-8511, Osaka, Japan.
Department of Clinical Laboratory, Tenri Hospital, 200 Mishima-cho, Tenri, 632-8552, Nara, Japan.
Heart Vessels. 2016 Sep;31(9):1562-9. doi: 10.1007/s00380-015-0767-9. Epub 2015 Oct 30.
Episodes of atrial fibrillation (AF) are mainly initiated by triggers from pulmonary veins (PVs). The superior vena cava (SVC) has been identified as a second major substrate of non-PV foci, but the electrophysiologic features of the SVC have not been fully investigated. We hypothesized that SVC ectopies are suppressed by predominant features of PV ectopies and tend to appear after PV isolation (PVI). We evaluated the electrophysiological characteristics and clinical implications of SVC ectopies in patients with AF during catheter ablation using high-dose isoproterenol and the atrial overdrive pacing maneuver. The manifestation patterns and modes of onset (coupling interval and appearance interval) of ectopies from both the PVs and SVC were investigated. 205 patients were enrolled [153 males and 52 females; mean age 64 ± 10 years; paroxysmal in 143 patients (69.8 %), persistent in 40 (19.5 %), and long-standing persistent in 22 patients (10.7 %)]. Before PVI, PV ectopies were detected in 182/205 patients (89 %). SVC ectopies were rarely observed before PVI but were significantly more frequent after the completion of PVI (3/205 vs. 14/205 patients, p = 0.011). The coupling interval (CI) and % CI (CI/preceding the A-A interval × 100) of PV ectopies were significantly shorter than those of SVC ectopies (211 ± 78 vs. 282 ± 106 ms, p = 0.021, and 34 ± 9 vs. 51 ± 17 %, p < 0.001, respectively). The appearance intervals of the PV ectopies were shorter than those of the SVC ectopies (6.3 ± 4.0 vs. 10.7 ± 6.7 s, p = 0.030). During repeat procedures, PVs with reconnection to the left atrium were less frequently observed in patients with SVC firing than in patients without SVC firing (1.7 ± 1.5 vs. 2.9 ± 1.1 PVs, p = 0.029). We demonstrated that PVI tends to manifest SVC ectopies with less spontaneous activity and that an elimination of predominant ectopies from the PVs may affect appearance of SVC ectopy.
房颤（AF）发作主要由肺静脉（PVs）触发。上腔静脉（SVC）已被确定为非肺静脉病灶的第二大主要基质，但上腔静脉的电生理特征尚未得到充分研究。我们假设上腔静脉异位搏动受肺静脉异位搏动的主要特征抑制，并倾向于在肺静脉隔离（PVI）后出现。我们使用高剂量异丙肾上腺素和心房超速起搏操作评估了导管消融期间房颤患者上腔静脉异位搏动的电生理特征和临床意义。研究了肺静脉和上腔静脉异位搏动的表现模式和发作方式（联律间期和出现间期）。共纳入205例患者[男性153例，女性52例；平均年龄64±10岁；阵发性房颤143例（69.8%），持续性房颤40例（19.5%），长期持续性房颤22例（10.7%）]。在肺静脉隔离前，205例患者中有182例（89%）检测到肺静脉异位搏动。肺静脉隔离前很少观察到上腔静脉异位搏动，但在肺静脉隔离完成后明显更频繁（3/205例对14/205例患者，p = 0.011）。肺静脉异位搏动的联律间期（CI）和CI百分比（CI/前一个A-A间期×100）明显短于上腔静脉异位搏动（分别为211±78 vs. 282±106 ms，p = 0.021，以及34±9 vs. 51±17%，p < 0.001）。肺静脉异位搏动的出现间期短于上腔静脉异位搏动（6.3±4.0 vs. 10.7±6.7 s，p = 0.030）。在重复手术期间，与无腔静脉触发的患者相比，有上腔静脉触发的患者中与左心房重新连接的肺静脉较少见（1.7±1.5 vs. 2.9±1.1条肺静脉，p = 0.029）。我们证明，肺静脉隔离倾向于表现出自发性活动较少的上腔静脉异位搏动，并且消除肺静脉的主要异位搏动可能影响上腔静脉异位搏动的出现。
