Regional endocardial mapping of spontaneous and induced atrial fibrillation in patients with heart disease and refractory atrial fibrillation.
Regional endocardial mapping of spontaneous and induced atrial fibrillation in patients with heart disease and refractory atrial fibrillation.
复制标题
心脏病和难治性心房颤动患者自发性和诱发性心房颤动的区域心内膜标测。
DOI：
10.1016/s0002-9149(99)00459-2
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
A. Shankar
中科院分区：
文献类型：
--
作者：
S. Saksena;A. Prakash;R. Krol;A. Shankar
我们对缺血性和/或高血压性心脏病患者的自发性房颤（AF）发作时和维持期间进行了右心房和左心房区域的同步导管标测。17例结构性心脏病患者的自发性和电诱导房颤发作从其发作时同时映射到多个右心房和左心房区域。引发自发性AF的房性早搏复合波（APC）的偶联间期范围为260 - 400 ms（平均332 ± 61），最常见于右心房外侧（31%）、右房室交界处（13%）、房间隔（6%）、上级左心房（25%）或左心房下部（25%）。表面心电图上的APC形态与特定心房区域的起源无关。第一个AF周期的最早心房激动区域为右心房外侧（n = 5）、左心房上级（n = 4）、冠状窦远端或中部（n = 4）、房间隔（n = 2）和希氏束位置处的右房室交界处（n = 2）。自发性房颤发作时通常在几乎所有标测的右心房和左心房部位显示离散但不规则的电描记图，在所有8例发生多起事件的患者中，房颤起始区域可重现。16例患者中有15例（94%）在自发性AF发作时最早的心房激动区域靠近APC起源，40次发作中有39次（97%）被标测。14例患者在房颤发作时观察到稳定的右心房和左心房激动模式。8例患者中有4例右心房刺激诱发的诱发性房颤与自发性房颤相比，发作时最早的区域性心房激动部位不同。然而，在所有标测的心房区域中，诱发性AF中也存在离散的心内电描记图。此外，还发现诱导性AF中的额外刺激递送的部位与第一次AF搏动的最早心房激活区域非常接近。我们的结论是，自发性房颤是由APC在不同的右或左心房区域的结构性心脏病患者和心房激活的初始区域在APC起源的区域附近。房颤发作时，经常在左右心房观察到有组织的重复性电激动。尽管在许多患者中，电诱导AF在发作时可能具有与自发性AF不同的激动模式，但两种类型的AF都在接近起始APC的位置显示出组织化和最早的心房激动。
We performed simultaneous catheter mapping of right and left atrial regions at onset and during sustenance of spontaneous atrial fibrillation (AF) in patients with ischemic and/or hypertensive heart disease. Seventeen patients with structural heart disease had spontaneous and electrically induced AF episodes mapped from their onset simultaneously in multiple right and left atrial regions. Atrial premature complexes (APCs) that initiated spontaneous AF had coupling intervals ranging from 260 to 400 ms (mean 332 ± 61), most commonly arising from the lateral right atrium (31%), right atrioventricular junction (13%), atrial septum (6%), superior left atrium (25%), or inferior left atrium (25%). APC morphology on surface electrocardiograms did not correlate with origin in specific atrial regions. The earliest regions of atrial activation for the first AF cycle were the lateral right atrium (n = 5), superior left atrium (n = 4), distal or mid coronary sinus (n = 4), atrial septum (n = 2), and right atrioventricular junction at the His bundle location (n = 2). Spontaneous AF at onset usually showed discrete but irregular electrograms at virtually all right and left atrial sites mapped, with a reproducible region of AF initiation in all 8 patients with multiple events. The region of earliest atrial activation at spontaneous AF onset was in close proximity to the APC origin in 15 of 16 patients (94%), and 39 of 40 episodes (97%) mapped. Stable patterns of right and left atrial activation were observed at AF onset in 14 patients. Induced AF elicited with right atrial stimulation demonstrated different sites of earliest regional atrial activation at onset compared with spontaneous AF events in 4 of 8 patients. However, discrete intracardiac electrograms were also present in induced AF in all of the mapped atrial regions. Furthermore, the site of extrastimulus delivery in induced AF was also found to be in close proximity to the earliest region of atrial activation for the first AF beat. We conclude that spontaneous AF is initiated by APCs arising in different right or left atrial regions in patients with structural heart disease and the initial region of atrial activation in AF is in proximity to the region of APC origin. Organized and repetitive electrical activation is frequently observed in both right and left atria at AF onset. Although electrically induced AF may have different activation patterns than spontaneous AF at onset in many patients, both types of AF demonstrate organization and earliest atrial activation in proximity to the initiating APC.
心房颤动的机制：母转子或多个子小波，或两者兼而有之？
DOI：
--
发表时间：
1998
期刊：
Journal of cardiovascular electrophysiology.
影响因子：
--
作者：
Jalife,J;Berenfeld,O;Skanes,A;Mandapati,R
通讯作者：
Mandapati,R
DOI：
10.1016/s0022-5223(19)36723-6
发表时间：
1991-03-01
影响因子：
6
作者：
COX, JL;CANAVAN, TE;BOINEAU, JP
通讯作者：
BOINEAU, JP