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目的探讨三维电解剖Carto指导下标测消融源于左心耳部位房性心动过速(房速)的方法和可行性。方法结合电生理和空间信息,首先利用Carto系统建立左心房三维解剖结构。对3例起源于左心耳的房速进行Carto标测,根据Carto标测来确定最早激动点,并以此为靶点进行射频消融。同时分析心动过速时体表心电图的P波特点。结果电解剖标测证实3例房速均为局灶性房速,其最早激动点起源于左心耳,并向左心房前壁、房间隔和后下壁激动。左心耳放电成功消融3例房速。体表心电图分析显示房速时Ⅱ、Ⅲ、aVF和V1导联P波为正向,I、aVL导联为完全负向。结论三维电解剖标测可以清楚显示左心耳解剖结构以及源于其中的房速的激动顺序并有利于经导管进行射频消融。
Objective To investigate the feasibility and feasibility of using Cartesian electrocardiography to guide the ablation of atrial tachycardia (atrial tachycardia) originated from the left atrial appendage. Methods Combining electrophysiological and spatial information, the Carto system was used to establish the three-dimensional anatomy of the left atrium. Cartesian mapping was performed on three cases of atrial fibrillation originating from the left atrial appendage, and the earliest point of activation was determined by Carto mapping and used as a target for radiofrequency ablation. At the same time analysis of tachycardia P wave surface ECG characteristics. Results Electro-anatomical mapping confirmed three cases of atrial tachycardia were focal atrial tachycardia, the earliest point of agitation originated in the left atrial appendage, and to the left anterior wall, atrial septal and posterior inferior wall. Left atrial appendage discharge successfully ablated 3 cases of atrial tachycardia. Surface electrocardiogram analysis showed that the atrial fibrillation Ⅱ, Ⅲ, aVF and V1 lead P wave is positive, I, aVL lead is completely negative. Conclusion Three-dimensional electroanatomic mapping can clearly show the anatomy of the left atrial appendage and the anomalous sequence of the antrum derived therefrom and facilitate catheter ablation.