Barkagan Michael, Michowitz Yoav, Glick Aharon, Tovia-Brodie Oholi, Rosso Raphael, Belhassen Bernard
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Pacing Clin Electrophysiol. 2016 Nov;39(11):1165-1173. doi: 10.1111/pace.12941. Epub 2016 Oct 4.
A few series of focal atrial tachycardia (AT) originating from the noncoronary sinus of Valsalva (NCSV) have been reported in the literature during the last decade.
Of 147 patients with AT referred for radiofrequency ablation (RFA), we identified nine (6%) originating in the vicinity of the NCSV. Clinical AT was induced during electrophysiological study in all patients without (n = 6) and with (n = 3) isoproterenol infusion. Mean cycle length of the induced tachycardia was 399 ± 85 ms. Mapping of the right atrium and of the left atrium (LA) was initially performed in all nine patients and in four patients, respectively. Earliest tachycardia activation occurred at the His bundle area in all cases. Earliest activations in the LA were at the low paraseptal regions. In two patients with antegrade dual atrioventricular (AV) node physiology that rendered difficult accurate distinction between atrial and ventricular activation, slow pathway ablation was necessary. A retrograde aortic approach was used for mapping the aortic cusps. The earliest local atrial activation in the NCSV preceded the atrial activation in the His area in all patients by 27 ± 8 ms. RFA was performed in all nine patients and was acutely successful in eight. Two patients required radiofrequency (RF) energy outputs of 50 W in order to terminate the arrhythmia. In one patient, successful AT ablation was associated with complete AV block requiring implantation of permanent pacemaker.
Focal AT can be successfully mapped and ablated in the NCSV. Higher than usual RF energy levels are sometimes required. Complete AV block is a possible complication.
在过去十年中，文献报道了少数起源于非冠状窦（NCSV）的局灶性房性心动过速（AT）系列病例。
在147例接受射频消融（RFA）的AT患者中，我们识别出9例（6%）起源于NCSV附近。所有患者在电生理研究期间均诱发出临床AT，其中6例未使用异丙肾上腺素，3例使用了异丙肾上腺素。诱发的心动过速平均周期长度为399±85毫秒。最初对所有9例患者进行了右心房标测，对4例患者进行了左心房（LA）标测。所有病例中最早的心动过速激动均出现在希氏束区域。LA中最早的激动出现在低位间隔旁区域。在2例具有房室（AV）结前传双径路生理特征、难以准确区分心房和心室激动的患者中，需要进行慢径路消融。采用逆行主动脉途径标测主动脉瓣叶。所有患者NCSV中最早的局部心房激动均比希氏区的心房激动提前27±8毫秒。9例患者均接受了RFA，8例即刻成功。2例患者需要50瓦的射频（RF）能量输出才能终止心律失常。1例患者成功消融AT后出现完全性AV阻滞，需要植入永久性起搏器。
NCSV中的局灶性AT可以成功标测和消融。有时需要高于平常的RF能量水平。完全性AV阻滞是一种可能的并发症。
