Hsieh M H, Chen S A, Tai C T, Chiang C E, Chang M S
Department of Medicine, National Yang-Ming University, School of Medicine, Taiwan.
J Interv Card Electrophysiol. 1998 Jun;2(2):203-9. doi: 10.1023/a:1009715919068.
The presence of ectopic rhythm has been considered to be the most important marker for successful slow pathway ablation, but the details of different ectopic rhythms have not been well described. This study included 83 consecutive patients with typical AV node reentrant tachycardia who underwent slow pathway ablation. The interval between the atrial signals of the His bundle electrogram and the distal ablation catheter [A(H)-A(Ab)], and the interval between the atrial components of the distal ablation catheter and the ostium of coronary sinus catheter [A(Ab)-A(CSos)] were measured. One hundred episodes of ectopic rhythm occurred with 81 (81%) successful applications. There are two different origins and three activation sequences of ectopic rhythms, including HIS rhythm (78 applications, the earliest atrial activation in the His bundle electrogram), CSos rhythm (6 applications, the earliest atrial signal in the coronary sinus ostium electrogram) and CSos preceding HIS (CSos-->HIS) rhythm (16 applications, the atrial activation sequences changing from CSos to HIS rhythm). The CSos rhythm had a shorter mean cycle length (445 +/- 81 vs. 511 +/- 132 vs. 579 +/- 140 ms, p < 0.05), a shorter [A(Ab)-A(CSos)] interval (-2.5 +/- 9.8 vs. 14.1 +/- 11.2 vs. 12.8 +/- 8.4 ms, p < 0.05) and a lower success rate (33% vs. 84% vs. 94% p < 0.05) than HIS rhythm and CSos-->HIS rhythm. Otherwise, the mean cycle length of ectopic rhythm was significant shorter in successful than in failed ablation (506 +/- 135 vs. 559 +/- 118 ms, p = 0.04). In conclusion, we found two different origins and three activation sequences of ectopic rhythms. CSos rhythm had a lower success rate in ablation of slow pathway, thus it was a poor marker for successful ablation.
异位心律的出现被认为是成功进行慢径路消融的最重要标志，但不同异位心律的细节尚未得到充分描述。本研究纳入了83例连续接受慢径路消融的典型房室结折返性心动过速患者。测量希氏束电图心房信号与远端消融导管之间的间期[A(H)-A(Ab)]，以及远端消融导管心房成分与冠状窦导管开口之间的间期[A(Ab)-A(CSos)]。81次（81%）成功消融时出现了100次异位心律发作。异位心律有两种不同起源和三种激动顺序，包括希氏束心律（78次发作，希氏束电图中最早的心房激动）、冠状窦口心律（6次发作，冠状窦口电图中最早的心房信号）和冠状窦口先于希氏束（CSos→HIS）心律（16次发作，心房激动顺序从冠状窦口心律变为希氏束心律）。冠状窦口心律的平均周期长度较短（445±81 vs. 511±132 vs. 579±140 ms，p<0.05），[A(Ab)-A(CSos)]间期较短（-2.5±9.8 vs. 14.1±11.2 vs. 12.8±8.4 ms，p<0.05），成功率较低（33% vs. 84% vs. 94%，p<0.05），与希氏束心律和CSos→HIS心律相比。此外，成功消融时异位心律的平均周期长度明显短于失败消融时（506±135 vs. 559±118 ms，p=0.04）。总之，我们发现异位心律有两种不同起源和三种激动顺序。冠状窦口心律在慢径路消融中的成功率较低，因此它是成功消融的不良标志。
