Madaffari Antonio, Große Anett, Brunelli Michele, Frommhold Markus, Dähne Tanja, Oreto Giuseppe, Raffa Santi, Geller J Christoph
Division of Cardiology, Department of Arrhythmia and Electrophysiology, Zentralklinik Bad Berka, Bad Berka, Germany.
Department of Clinical and Experimental Medicine, University Hospitals, Messina, Italy.
J Cardiovasc Electrophysiol. 2016 Feb;27(2):175-82. doi: 10.1111/jce.12847. Epub 2015 Nov 6.
Radiofrequency (RF) ablation of atrial tachycardia (AT) with earliest activation at the His-bundle may be associated with the risk of AV block, and detection of this AT origin using the electrocardiogram (ECG) would be helpful in planning ablation. Aim of this study was to characterize the P-wave morphology and intracardiac electrograms at the successful ablation site for this group of ATs.
All consecutive patients undergoing ablation for AT with earliest activation at the His-bundle were included. Twelve-lead ECG and intracardiac electrograms were analyzed.
A total of 33 patients underwent successful ablation. The P-wave and the PR interval during AT (cycle length 460 ± 88, range 360-670 milliseconds) were significantly shorter compared to sinus rhythm 87 ± 18 vs. 117 ± 23 and 131 ± 37 vs. 170 ± 47 milliseconds, respectively, P < 0.01. In 28 patients (85%), the P-wave was biphasic (-/+) or triphasic (+/-/+) in the precordial leads, especially V4 -V6 , and in 25 patients (76%) it was biphasic (-/+) or triphasic (+/-/+) in the inferior leads. RF was delivered at the following locations: noncoronary aortic cusp (NCC) in 24 patients, antero-septal left atrium in 4, supero-septal right atrium in 3, left coronary cusp in 1, and between the right coronary cusp and the NCC in 1. Atrial bipolar electrograms at the successful ablation site preceded the P-wave by 38 ± 11 (range 10-60) milliseconds, and AT termination was obtained after a mean RF energy time of 10 ± 8 (range 2-31) seconds.
A characteristic narrow and biphasic (-/+) or triphasic (+/-/+) P-wave in the inferior and precordial leads reliably identifies the group of AT arising from the para-Hisian region.
最早激动位于希氏束的房性心动过速（AT）行射频消融可能会有发生房室传导阻滞的风险，利用心电图（ECG）检测该AT起源有助于规划消融治疗。本研究的目的是描述这组AT成功消融部位的P波形态和心内心电图特征。
纳入所有因最早激动位于希氏束而行AT消融的连续患者。分析12导联心电图和心内心电图。
共有33例患者成功消融。与窦性心律相比，AT时（周长460±88，范围360 - 670毫秒）的P波和PR间期显著缩短，分别为87±18对117±23毫秒以及131±37对170±47毫秒，P<0.01。28例患者（85%）胸前导联尤其是V4 - V6导联的P波呈双相（ - / +）或三相（ + / - / +），25例患者（76%）下壁导联的P波呈双相（ - / +）或三相（ + / - / +）。射频消融部位如下：24例位于无冠瓣（NCC），4例位于房间隔左心房，3例位于上间隔右心房，1例位于左冠瓣，1例位于右冠瓣与NCC之间。成功消融部位的心房双极电图较P波提前38±11（范围10 - 60）毫秒，平均射频能量施加10±8（范围2 - 31）秒后AT终止。
下壁和胸前导联特征性的窄双相（ - / +）或三相（ + / - / +）P波可可靠地识别起源于希氏束旁区域的这组AT。
