目的 报道经环肺静脉电隔离后发现上腔静脉触发灶的心房颤动(简称房颤)及电隔离.方法 2009年10月至2011年6月行肺静脉电隔离治疗的阵发性房颤患者451例,电隔离后另行上腔静脉电生理检查,明确有否上腔静脉起源的房颤.结果 27例有起源于上腔静脉的房颤(6％),其中22例为上腔静脉早搏触发房颤,5例为上腔静脉房性心动过速驱动心房快速激动.27例中7例为基础状态下发作房颤,其余为异丙肾上腺素和三磷酸腺苷或者电复律后诱发.均于上腔静脉与右房交界上方约1 ～2 cm处行上腔静脉电隔离.随访6～32个月,3例复发.结论 上腔静脉起源的房颤在阵发性房颤中发生的比例为6％.上腔静脉电隔离后长期复发率较低.%Objective To report the clinical experience of catheter ablation of atrial fibrillation (AF) originating from superior vena cava (SVC).Methods Patients with documented SVC-originated AF from a pool of paroxysmal AF (451 cases) who underwent catheter ablation procedure during the past 2 years were enrolled,their clinical and electrophysiological characteristics were systematically analyzed.Results The AF in 27 patients (M/F=12/15 cases,mean age of 52.3 ± 12.5 years old) were confirmed to be originated from SVC (6％).The sustainable AF or atrial tachycardia were found to be triggered or driven by fast activations within SVC and were terminated by isolation of SVC,either with or without any inducing technique (isoproterenol,adenosine triphosphate and cardioversion during AF).After a mean period of 15-month follow up,3 patients recurred and one patient received repeat procedure.No complications were found.Conclusion Totally 6％ of paroxysmal AF are originated from SVC.Detailed electrophysiological study including isoproterenol and bolus injection of adenosine-triphosphate may help to reveal the culprit sources.
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