摘要
目的通过对典型逆钟向心房扑动（房扑）左右心房的电解剖标测，阐明其房扑波的产生机制及右心房游离壁电压与房扑波终末部分形态的关系。方法入选南京医科大学第一附属医院2008年9月至2014年2月35例典型逆钟向房扑患者，按照是否进行了双心房标测分为2组。第1组患者均无右心房游离壁的手术瘢痕，进行了左右心房的双心房标测，第2组患者按照有无右心房游离壁瘢痕分为2a和2b亚组，只进行了右心房的激动标测。所有患者均进行详细的电生理检查及三维标测系统指导下的心房激动标测，观察房扑波的形成与左右心房心内膜激动模式的关系并分析出右心房游离壁电压与房扑波终末部分形态的关系。结果35例患者平均年龄分别为（60．27±13．48）岁（组1），（43．14±17．48）岁（组2a）和（54．25±17．88）岁（组2b）。完成房扑节律下右心房、左心房的电解剖重建。在下壁导联，F波可以分为3个部分，第1部分是缓慢传导期，对应三尖瓣峡部的缓慢传导；第2部分是快速下降期，对应右心房间隔面及左心房的激动传导；第3部分是终末的正向成分，对应右心房游离壁的激动传导。终末成分的振幅和游离壁电压具有正相关（r〈1，P〈0．05），除此之外，具有右心房游离壁瘢痕的患者其房扑波终末正向成分占总房扑波振幅的比值明显低于没有右心房游离壁瘢痕的患者（0．335±0．087对0．523±0．075，P〈0．05）。结论典型逆钟向房扑波与其特殊的大折返激动组成部分一一对应，是其特征性激动模式的心电反映。终末成分的振幅和右心房游离壁电压具有正相关。
Objective To investigate how the intra-cardiac activation translate into the characterized flutter wave in cavatricuspid isthmus-dependent counter-clockwise atrial flutter （CTI-AFL） and what is the re- lationship between fight atrial free wall scar and morphology of terminal part in flutter wave. Methods In to- tal ,35 cases of CTI-AFL from The First Affiliated Hospital of Nanjing Medical University were enrolled in the study. They were divided into two groups according to the mapping of dual atrium or the right atrium. The pa- tients in the first group did not have scar at the free wall of fight atrium, they underwent the dual atrium map- ping. The patients in the second group were underwent right atrium mapping,they were divided into 2a and 2b by the exist of scar at the free wall of right atrium. The activation map was reconstructed during AFL rhythm for left atrium and right atrium using 3-dimensional mapping system. The flutter wave in surface electrocardiogram was analyzed combined with the intra-cardiac activation. Results The mean age was 60. 27 ± 13.48 years （ group 1 ） ,43. 14±17. 48 years （group 2a） and 54. 25±17. 88 years（group 2b）. The activation map was completed in all cases. In inferior leads, the flutter wave was divided into three parts. The slowly downward part, sharp downward part and the terminal positive part. The three parts were corresponded to the fixed activation part of the macro- reentry. The amplitude of terminal part of flutter wave had some positive relationship with the voltage of right atrial free wall （r〈l, P〈0.05 ）. Furthermore, the ratio of amplitude of terminal positive part to that of whole flutter wave in patients with scar at right atrial free wall was less then patients without scar （0. 335±0. 087 vs. 0. 523±0. 075,P〈0. 05）. Conclusion The distinctive flutter wave of CTI-AFL was determined by the unique macro-reentry activation in the right atrium determines. The voltage of right atrium free wall has a positive cor- responding on the morp
出处
《中华心律失常学杂志》
2015年第6期426-430,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
心房扑动
心电图
心内膜标测
机制
Atrial flutter
Electrocardiogram
Intra-cardiac mapping
Mechanism
