CELLULAR MECHANISMS FOR CARDIAC-ARRHYTHMIAS
CELLULAR MECHANISMS FOR CARDIAC-ARRHYTHMIAS
复制标题
DOI：
10.1161/01.res.49.1.1
复制
发表时间：
1981-01-01
影响因子：
20.1
通讯作者：
ROSEN, MR
中科院分区：
文献类型：
--
作者：
HOFFMAN, BF;ROSEN, MR
我们多年来采用的心律失常的一般分类（Hoffmann, 1960; Hoffman and Cranefield, 1964; Wit et al., 1974a, 1974b, 1974c）假设所有心律紊乱都是由电活动的两种主要异常之一引起的。第一个是脉冲启动的异常，第二个是脉冲传播的异常。此外，由于没有理由先验地假设这两种情况可能不会共存，我们将一些心律失常归类为由冲动启动和传导共存的异常引起的。对于由异常脉冲启动引起的心律失常，我们假设节律是自动的，即一个脉冲的产生在任何关键方面都不依赖于先前的脉冲。因此，异常自动性所致的心律失常可能是由于正常自动机制的改变或异常自动机制的发展所致。总的来说，这个简单的方案只在一个重要的方面进行了修改。最近对浦肯野纤维异常电活动和房室瓣膜（Wit and Cranefield, 1976）和冠状窦（Wit and Cranefield, 1977）纤维电活动的研究导致了触发性心律失常的概念。触发节律不同于真正的自动节律，因为异常脉冲或重复活动是由自动或受刺激的动作电位引起的。在没有这种动作电位（“触发器”）的情况下，不会发生激活或重复放电。这是一个非常重要的概念，尽管关于自动节奏和触发节奏之间差异的一些问题的答案仍然没有定论，但最近有两个详细的考虑
THE general classification of cardiac arrhythmias that we have employed for a number of years (Hoffmann, 1960; Hoffman and Cranefield, 1964; Wit et al., 1974a, 1974b, 1974c) assumed that all disturbances of rhythm resulted from one of two primary abnormalities in electrical activity. The first was an abnormality in impulse initiation and the second an abnormality in impulse propagation. Also, because there was no reason to assume a priori that these two conditions might not coexist, we classified some arrhythmias as resulting from coexisting abnormalities of impulse initiation and conduction. For the arrhythmias due to abnormal impulse initiation we assumed that the rhythms were automatic in the sense that generation of one impulse did not depend in any crucial way on a prior impulse. Arrhythmias due to abnormal automaticity thus might arise from some change in the normal automatic mechanism or from the development of some abnormal automatic mechanism. In general, this simple scheme has been modified in only one important way. Recent studies on abnormal electrical activity of Purkinje fibers and on the electrical activity of fibers in the AV valves (Wit and Cranefield, 1976) and coronary sinus (Wit and Cranefield, 1977) have led to the concept of triggered arrhythmias. A triggered rhythm differs from a truly automatic rhythm in the sense that the abnormal impulse or repetitive activity is initiated by either an automatic or a stimulated action potential. In the absence of such an action potential (the" trigger") activation or repetitive firing does not occur. The concept is quite an Important one and, although the answers to some questions about differences between automatic and triggered rhythms remain moot, two recent detailed considerations of