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目的以三维电解剖标测系统(Carto3)标测经股静脉途径行导管消融的心脏结构正常的患者的窦房结最早激动点。方法选择2014年7月至2015年4月在白求恩国际和平医院心血管内科经股静脉途径行导管消融的74例心律失常患者,由同一术者完成手术。手术在Carto3指导下完成消融后,以FAM方式重建上腔静脉和部分右心房,在窦性心律下以高密度激动标测寻找窦房结最早激动点。结果 74例患者经检查排除器质性心脏病,窦房结最早激动点至上腔静脉的距离(纬度)为27.05±7.54mm(16~52mm,中位数26.85 mm),其中距离为20~35 mm者54例(占72.97%)。在LAO45°+SUP体位标测窦房结(经度)中位数位于9点钟(5~12点钟),其中9点钟30例(占40.54%)。结论三维电解剖标测窦房结最早激动点快速、便捷;窦房结位置变异可以部分解释正常窦性心律的P波形态不单一;导管射频消融治疗右房上部心律失常时需先标测窦房结位置,避免发生窦房结损伤并发症。
Objective To measure the earliest node of sinoatrial node in patients with normal cardiac structure by catheterization of the femoral vein through a Cartesian Electroanatomic Mapping System (Carto3). Methods From July 2014 to April 2015, 74 patients with arrhythmia undergoing catheter ablation in the Department of Cardiology, Bethune International Peace Hospital were enrolled in the same operation. Surgery under the guidance of Carto3 after the completion of ablation, FAM reconstruction of the superior vena cava and part of the right atrium, sinus rhythm high-density excitement mapping search for the earliest point of activation of the sinus node. Results 74 patients were excluded from structural heart disease examination. The distance (latitude) between the earliest point of sinoatrial node and the superior vena cava was 27.05 ± 7.54mm (16 ~ 52mm, median 26.85mm), of which the distance was 20 ~ 35 mm in 54 cases (accounting for 72.97%). The median of sinoatrial node (longitude) at LAO45 ° + SUP was located at 9 o’clock (5-12 o’clock), 30 of which (40.54%) at 9 o’clock. Conclusion The three-dimensional electroanatomical mapping of sinoatrial node early excitement point fast and convenient; sinus node position variation can be partially explained the normal sinus rhythm of P wave morphology is not uniform; catheter radiofrequency ablation of the right atrium in the upper arrhythmia need to mark the sinus End location of the node to avoid the occurrence of sinus node injury complications.