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題名 | Predictors of Non-Pulmonary Vein Ectopic Beats Initiating Paroxysmal Atrial Fibrillation--Implication for Catheter Ablation=非肺靜脈異位發電所引發陣發性心房顫動的預測因子--導管灼燒術的應用 |
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作 者 | 李世煌; 陳適安; 戴慶泰; | 書刊名 | Acta Cardiologica Sinica |
卷期 | 23:1 2007.03[民96.03] |
頁次 | 頁13-19 |
分類號 | 415.318 |
關鍵詞 | 心房顫動; 肺靜脈; 上腔靜脈; 導管電燒; Atrial fibrillation; Pulmonary vein; Superior vena cava; Catheter ablation; |
語文 | 英文(English) |
中文摘要 | 非肺靜脈的異位發電已證實會在某些病人引發陣發性心房顫動,而且非肺靜脈的異位發電在陣發性心房顫動病人接受肺靜脈隔絕電燒術後復發心房顫動扮演重要的角色。這篇回顧文章討論非肺靜脈電位發電所引發心房顫動病人的鑑別診斷,電燒策略,解剖基礎和臨床預測因子。通常要正確診斷非肺靜脈心房顫動,體表心電圖的P波和心內電氣紀錄是很重要的,在臨床工作時,左心房擴大可以預測左心房後壁異位發電所引發的陣發性心房顫動,在左心房擴大的病人左心房後壁自動去極化可能有增加的情形,女性性別可以預測上腔靜脈的異位發電,上腔靜脈異位發電引發陣發性心房顫動發生率的性別差異可能是由於男性和女性有不同的女性荷爾蒙和自主神經功能。將來的研究應探討女性荷爾蒙和自主神經在上腔靜脈異位發電所扮演的角色。 |
英文摘要 | Non-pulmonary vein (PV) ectopic beats have been proven to initiate paroxysmal atrial fibrillation (PAF) in some patients, and the presence of non-PV ectopic beats might play an important role in the recurrence of PAF after PV isolation. This review article discusses the differential diagnosis, ablation strategy, anatomical substrate and clinical predictors in patients with non-PV ectopic beats initiating AF. In general, P wave morphology of surface ECG and intracardiac recordings are important in making an accurate diagnosis of non-PV AF. In clinical practice, left atrial enlargement could predict the presence of left atrial posterior free wall (LAPFW) ectopic beats initiating PAF; increased automaticity and increased trigger activity from the LAPFW might occur in patients with left atrial enlargement. Furthermore, female gender could predict the presence of superior vena cava (SVC) ectopic beats initiating AF; the gender difference in the incidence of SVC ectopic beats initiating PAF might be explained by the gender difference in female hormones and/or autonomic activities. Further studies are needed to define the exact effects of female hormones and autonomic tone on the SVC ectopic beats initiating PAF. |
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