【摘要】 目的探讨峡部依赖性心房扑动(房扑)心房间传导途径及其与心房扑动(FL)波的关系,以及冠状静脉窦(CS)和Halo导管激动时间与FL波的对应关系。方法对20例峡部依赖性房扑患者行电生理检查,常规放置CS、His、Halo电极导管,观察CS、Halo导管激动顺序及其与FL波在时间上的对应关系。结果4例为顺时针房扑(clockwise-AFL,CW-AFL),其中3例心电图下壁及V\-6导联FL波以正相为主；16例为逆时针房扑(counterclockwise-AFL,CCW-AFL),其中13例心电图下壁导联FL波以负相波为主。CW-AFL患者2例冲动由CS近端向远端传导,2例冲动由CS远、近两端向中部传导；13例CCW-AFL患者冲动由CS近端向远端传导。仅1名(25％)CW-AFL患者CS激动时间对应体表心电图下壁导联FL波的升支,冲动由冠状静脉窦口(CSO)向上传导至右心房前侧壁的时间对应下壁导联FL波降支；13例CCW-AFL患者CS激动时间对应体表心电图下壁导联FL波降支,冲动自右心房前侧壁向CSO传导时间对应下壁导联FL波升支和正相切迹。结论CCW-AFL时冲动主要经CSO传导至左心房,CW-AFL时冲动可经CSO或Bachmann束(BB)传导至左心房。FL波的极性主要取决于心房间传导途径和左心房激动顺序。CCW-AFL时FL波与心房内特定部位激动时间有一定对应关系,但在CW-AFL时这种对应关系并不常见。更多还原

【Abstract】 Objective To determine the atrial activation pattern in isthmus-dependent atrial flutter (AFL)and to understand the functional interatrial connections and the temporal relationships between the atrial endeeardial activity and the surface electrocardiogram(ECG).Methods Twenty patients with cavotricuspid isthmus(CTI)-dependent atrial flutter referred for radiofrequency ablation were examined.All the patients un- derwent electrophysiological study with CS and His recordings.A“halo”catheter was placed in a counterclock- wise orientation against the tricuspid annulus(TA).Patterns of CS and Halo activation and their relationship with the flutter wave( FL wave)in the surface ECG were analyzed.Results In 3 of 4 clockwise-AFL(CW- AFL)cases,the polarity of FL wave in inferior lead was positive;in 13 of 16 counterclockwise-AFL(CCW- AFL)cases,the polarity of FL wave in inferior lead was negative.During CW-AFL,CS activation was proximal- to-distal pattern in 2 patients and fused in 2 patients.During CCW-AFL,CS activation was proximal-to-distal pattern in 13 of 16 patients.In CW-AFL,the upstroke component of the FL wave in the inferior leads coincided with activity recorded in CS electrograms and the negative deflections coincided with the activation of the lateral wall of RA in only 1 of 4 patients.In CCW-AFL,the negative component of the FL wave in the inferior leads co- incided with activity recorded in CS electrograms and the upstroke deflections and the positive notch coincided with the activation of the lateral wall of RA in 13 of 16 patients.Conclusion The left atrium is activated pre- dominantly over the coronary sinus orifice(CSO)in CCW-AFL and over Bachmann’s bundle or CSO during CW- AFL.Polarity of the FL wave is a manifestation of passive left atrial depolarization and trans-septal conduction. The electrical activity in surface ECG closely correlates with conduction in specific parts of the atria in CCW- AFL,but it is not a frequent phenomenon in CW-AFL.更多还原