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目的:分析起源于肺静脉的房性心律失常体表心电图和心内电生理特点,识别触发心房纤颤(房颤)的房性期前收缩(房早)和房性心动过速(房速)。方法:回顾性分析房性心律失常并阵发性房颤84例体表心电图(房颤组),非房颤组84例体表心电图为频发房早(>800次/24 h)。房颤组结合心内电生理检查及Lasso环状电极标测,行导管射频消融(RFCA)肺静脉隔离(PVI)。结果:房颤组电隔离肺静脉286支,均达即刻成功标准,无并发症发生。房颤组体表心电图呈房早、房速、心房扑动(房扑)和阵发性房颤(房颤)频繁发作和交替转换,并常伴长间歇,房早联律间期470～280(420±57)ms明显短于非房颤组的房早联律间期660～350(610±86)ms,P<0.05,房颤多由短联律间期房早触发。心内电生理改变为Lasso环状电极标测到起源于肺静脉的连续、快速、有序或无序的较P波提前,时限短、峰锐利的尖峰电位(Spike电位),同步心电图显示该Spike电位常是阵发性房颤的触发因素。经导管射频消融消除肺静脉内电位或隔离肺静脉与心房间的电或组织连接,可终止房性心律失常,维持窦性心律。结论:起源于肺静脉的房性心律失常的特点是短联律间期房早,也是阵发性房颤的触发因素。
PURPOSE: To analyze the surface electrocardiogram (ECG) and intracardiac electrophysiological characteristics of atrial arrhythmias originating in the pulmonary veins and to identify atrial premature contractions (atrial tachycardia) and atrial tachycardia (atrial tachycardia) that trigger atrial fibrillation . Methods: Eighty-four cases of atrial fibrillation (atrial fibrillation group) with atrial arrhythmia and paroxysmal atrial fibrillation were retrospectively analyzed. Body surface electrocardiogram in 84 cases of non-atrial fibrillation group was frequent atrial fibrillation (> 800 times / 24 h). Atrial fibrillation group combined with intracardiac electrophysiological examination and Lasso ring electrode mapping, catheter radiofrequency catheter ablation (RFCA) pulmonary vein isolation (PVI). Results: A total of 286 isolated pulmonary veins were electrically isolated in atrial fibrillation group, with immediate success criteria and no complications. Atrial fibrillation body surface electrocardiogram showed atrial fibrillation, atrial tachycardia, atrial flutter (atrial flutter) and paroxysmal atrial fibrillation (atrial fibrillation) frequent attacks and alternating conversion, and often accompanied by long intermittent, 280 (420 ± 57) ms was significantly shorter than that of non-AF group (660-350 ± 610 (86 ± 86) ms), P <0.05. Intracardiac electrophysiological changes were detected in Lasso’s ring electrode. The continuous, rapid, orderly or disorderly P wave originated in the pulmonary veins was earlier than the P wave and had a short duration and a sharp peak spike potential. Synchronic electrocardiograms showed that the Spike Potentials are often triggers of paroxysmal atrial fibrillation. Radiofrequency catheter ablation to eliminate the potential of the pulmonary vein or isolated pulmonary venous and cardiac electrical or tissue connections, can terminate atrial arrhythmias, to maintain sinus rhythm. CONCLUSIONS: Atrial arrhythmias that originate in the pulmonary veins are characterized by the presence of short-term interphase and early-onset and are also triggers of paroxysmal atrial fibrillation.