Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Clin Cardiol. 2021 Apr;44(4):563-572. doi: 10.1002/clc.23577. Epub 2021 Feb 18.
Although epicardial structures around the atrium such as adipose tissue possess arrhythmogenicity, little is known about atrial tachycardias (ATs) originating from epicardial sites (Epi-ATs). This study aimed to elucidate the prevalence, characteristics, and outcome after radiofrequency catheter ablation (RFCA) of Epi-ATs and to reveal the association between Epi-ATs and the epicardial structures.
The electrocardiographic, electrophysiologic, and anatomical properties and results of RFCA were analyzed in 42 patients with a total of 49 ectopic ATs.
Six Epi-ATs (12%) were observed in six patients (14%). Four of six were respiratory cycle-dependent ATs and one was a swallowing-induced AT. The Epi-AT origins were adjacent to a pulmonary vein (five cases) and vein of Marshall (one case). A Valsalva maneuver or atropine infusion to define the arrhythmia mechanism affected the appearance of the Epi-ATs. The congruity rate between epicardial adipose tissue and the AT origin was significantly higher (100% vs. 44%, p = .045), and the epicardial adipose tissue volume of the atrium was significantly larger (104.1 vs. 64.6 ml, p = .04) in the Epi-AT group. Endocardial RFCA targeting the AT foci resulted in acute success in five of five cases. However, electrical isolation including of the AT foci resulted in acute failures (two of three cases) or a recurrence (one of one case).
Six Epi-ATs were associated with thoracic veins and epicardial arrhythmogenic structures. The main cause provoking the Epi-ATs was associated with autonomic nerve activity.
尽管心房周围的心外膜结构（如脂肪组织）具有致心律失常性，但对于起源于心外膜部位的房性心动过速（AT）知之甚少。本研究旨在阐明心外膜 AT（Epi-AT）的发生率、特征和射频导管消融（RFCA）后的结果，并揭示 Epi-AT 与心外膜结构之间的关联。
分析了 42 例共 49 例异位 AT 患者的心电图、电生理和解剖特性及 RFCA 结果。
在 6 例患者中观察到 6 例 Epi-AT（12%）。6 例中有 4 例是呼吸周期依赖性 AT，1 例是吞咽诱发的 AT。Epi-AT 的起源紧邻肺静脉（5 例）和Marshall 静脉（1 例）。Valsalva 动作或阿托品输注定义心律失常机制会影响 Epi-AT 的出现。心外膜脂肪组织与 AT 起源的一致性率明显更高（100%比 44%，p =.045），Epi-AT 组心房心外膜脂肪组织体积明显更大（104.1 比 64.6ml，p =.04）。针对 AT 灶的心内膜 RFCA 可使 5 例中的 5 例即刻成功。然而，包括 AT 灶在内的电隔离导致即刻失败（3 例中的 2 例）或复发（1 例中的 1 例）。
6 例 Epi-AT 与胸静脉和心外膜致心律失常结构相关。引起 Epi-AT 的主要原因与自主神经活动有关。
