Department of Cardiology, UN Mehta Institute of Cardiology and Research Centre, Civil hospital campus, Asarwa, Ahmedabad, Gujarat, India.
Baroda Heart Institute and Research Centre, Vadodara, India.
Europace. 2018 Jan 1;20(1):124-133. doi: 10.1093/europace/euw324.
The clinical characteristics of atrial tachycardias (AT) ablated from the non-coronary aortic sinus (NCS) are thus far described only in small series. We aimed to outline, in a large cohort of patients, the clinical, electrocardiographic, electrophysiological characteristics of this tachycardia.
We analysed data pertaining to clinical, electrocardiographic, and electrophysiological characteristics of 43 consecutive patients from an overall cohort of 441 with AT who were successfully ablated from the NCS. The tachycardias ablated from the NCS were paroxysmal (98%) and adenosine sensitive (35/35). The patients were aged 54.6 ± 12.4 years, showing female preponderance (74%). No P wave pattern was predictive of the location of ablation. Electrophysiological findings suggested a possible micro-reentrant mechanism. During tachycardia, atrial electrograms recorded in the NCS preceded the A in the His region by 10.9 ± 7.4 ms. Fractionated atrial electrograms were noted at the site of ablation in 42 patients during the tachycardia. Radiofrequency ablation terminated the tachycardia within 5 s in 88%, with thermal automaticity seen only in 3 patients. The site of ablation at the base of the NCS was adjacent to the presumed site of the retroaortic node, a remnant of the initial atrio-ventricular canal musculature.
AT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit.
目前，从非冠状动脉窦（NCS）消融的房性心动过速（AT）的临床特征仅在小系列中描述。我们旨在在大量患者中概述这种心动过速的临床、心电图、电生理特征。
我们分析了来自 441 例 AT 患者的整体队列中 43 例连续患者的临床、心电图和电生理特征数据，这些患者均成功地从 NCS 消融。从 NCS 消融的心动过速为阵发性（98%）和腺苷敏感（35/35）。患者年龄为 54.6±12.4 岁，表现为女性优势（74%）。没有 P 波模式可预测消融部位。电生理发现提示可能存在微折返机制。在心动过速期间，在 His 区记录的 NCS 中的心房电图比 A 提前 10.9±7.4 ms。在 42 例心动过速患者中，在消融部位记录到心房电图呈碎裂。88%的患者在 5 s 内射频消融终止心动过速，仅 3 例患者出现热自动性。NCS 基底的消融部位紧邻推测的主动脉后结部位，这是初始房室管肌肉的残余。
从 NCS 消融的 AT 是中年女性的阵发性心律失常，具有独特的心电图和电生理特征。我们怀疑主动脉后结参与了心动过速的环路。
