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起源于主动脉-二尖瓣连续部的局灶性房性心动过速:解剖学和电生理学特征。

Focal atrial tachycardias originating from the aorta-mitral continuity: Anatomical and electrophysiological characteristics.

机构信息

State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Cardiology, Peking University Third Hospital, Beijing, China.

出版信息

Heart Rhythm. 2024 Oct;21(10):1867-1876. doi: 10.1016/j.hrthm.2024.04.011. Epub 2024 Apr 6.

Abstract

BACKGROUND

The aorta-mitral annulus conjunction (AMC) is an uncommon site of origin of focal atrial tachycardias (ATs). Hence, the electrophysiological and ablation target characteristics are poorly described.

OBJECTIVE

The purpose of this study was to describe the characteristics of AMC ATs in detail.

METHODS

The study enrolled 650 patients with ATs, 21 (3.2%) of whom had ATs originating from the AMC. A comprehensive evaluation, including electrocardiography, electrophysiology study, computed tomography scan, and intracardiac echocardiography, was performed.

RESULTS

The majority (19, 90.5%) of ATs occurred spontaneously. The mean age of this group was 48.9 ± 21.6 years, with 12 being female (57.1%). Seventeen patients had a typical biphasic P wave with a prominent positive component. The earliest activation site in the right atrium was near the His bundle, with average activation -10.3 ± 6.0 ms preceding the P wave. The successful ablation targets were distributed as follows: 1 case at 9 o'clock, 6 cases at 10 o'clock, 7 cases at 11 o'clock, 6 cases at 12 o'clock, and 1 case in the left coronary cusp. The local AMC potential differed from the commonly perceived annular potential and was characterized by a prominent A wave and a smaller V wave (atrial-to-ventricular ratio > 1). The angle of encroachment on the left atrial anterior wall, compressed by the left coronary cusp, was significantly smaller in the AMC ATs group than in the control group consisted of 40 patients who underwent coronary artery CT scans because of the chest pain but without atrial arrhythmias were randomly selected, which may have contributed to the arrhythmia substrate (141.7° ± 11.5° vs 155.2° ± 13.9°; P = .026).

CONCLUSION

A new strategy for mapping AMC ATs has been introduced. The ablation target should have an atrial-to-ventricular ratio of >1.

摘要

背景

主动脉瓣环-二尖瓣环连接部(AMC)是局灶性房性心动过速(AT)少见的起源部位。因此,其电生理和消融靶点特征描述较差。

目的

本研究旨在详细描述 AMC AT 的特征。

方法

该研究纳入了 650 例 AT 患者,其中 21 例(3.2%)起源于 AMC。进行了全面评估,包括心电图、电生理研究、计算机断层扫描和心内超声心动图。

结果

大多数(19 例,90.5%)AT 自发发生。该组的平均年龄为 48.9±21.6 岁,其中 12 例为女性(57.1%)。17 例患者的 P 波呈典型双相,正向成分明显。右心房最早激活部位靠近希氏束,平均比 P 波提前-10.3±6.0ms。成功的消融靶点分布如下:9 点 1 例,10 点 6 例,11 点 7 例,12 点 6 例,左冠状动脉瓣 1 例。局部 AMC 电位不同于通常感知的环状电位,特征为 A 波明显,V 波较小(心房-心室比>1)。与因胸痛而随机选择的 40 例接受冠状动脉 CT 扫描但无房性心律失常的对照组相比,左冠状动脉瓣压迫左心房前壁时,AMC AT 组的侵犯角度明显较小,可能有助于心律失常基质(141.7°±11.5°比 155.2°±13.9°;P=0.026)。

结论

引入了一种新的 AMC AT 映射策略。消融靶点的心房-心室比应>1。

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