Topography of the AV node and left-sided His-bundle recordings.
Topography of the AV node and left-sided His-bundle recordings.
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房室结地形和左侧希氏束记录。
DOI：
10.1016/j.hrthm.2006.11.029
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发表时间：
2007
期刊：
影响因子：
5.5
通讯作者：
Racker,DarleneK
中科院分区：
文献类型：
--
作者：
Racker,DarleneK
房室结折返性心动过速（AVNRT）是临床上最常见的室上性心动过速的原因，但其“精确”途径仍不清楚。1对房室结、其周围及其传导途径的地形图的误解可能与解剖学和电学研究数据的差异有关。2 Katritsis等人的报告，在HeartRhythm，2006; 3：993-1000中认为房室结是一种间隔结构（p.993）。然而，正如Tawara在世纪前对不同物种（包括狗和人）的组织切片、整个心脏和示意图所示，4：A、B房室结位于中央纤维体内，深至后非冠状动脉瓣尖，因此不可能位于房间隔内。我已经在狗5：图3; 6-9和人类（未发表的数据）心脏中验证了这些关联。房室结是心内结构。其地形刚好位于三尖瓣内侧叶前半部分的上级，并且在心室流出道深至后主动脉瓣尖，即人类心脏中的“心室流出道的房室间隔”。因此，房室结和希氏束都不与房间隔相关，房间隔与卵圆窝相关，并且在人类心脏中距离这些结构两厘米。10点整：图他们还考虑到：1）放置在主动脉后瓣3囊袋中的所谓左侧希氏束导管位于间隔左侧; 2）此处记录希氏束电位。然而，后主动脉袋在“心房内侧壁”和“心房主动脉隔膜”的水平处而不是心房隔膜处附着于右心房;并且所谓的希氏电位可能来自房室结。目前正在编写一份关于人类心脏中这些联系的全面报告。这些细节表明，AVNRT的清晰理解必须考虑到真实的解剖结构。
AV node reentrant tachycardia (AVNRT) is the most common cause of supraventricular tachycardia seen in clinical practice, yet the “precise” pathways are still unknown. 1 Misconceptions regarding the topography of the AV node, its environs, and its transmission pathways may relate to differences in data among anatomic and electrical studies. 2The report by Katritsis et al., in Heart Rhythm, 2006; 3: 993–1000 considers the AV node a septal structure (p. 993). However, as illustrated by Tawara a century ago for different species including dog and human in histologic sections, whole heart and schematics, 4: Figs. A, B the AV node is located within the central fibrous body, and deep to the posterior noncoronary aortic cusp, thus it cannot be in the atrial septum. I have verified these associations in dog5: Fig. 3; 6–9 and human (unpublished data) hearts. The AV node is an intracardiac structure. Its topography is just superior to the anterior half of the medial tricuspid leaflet, and at the ventricular outflow tract deep to the posterior aortic cusp, the “atrioventricular septum of the ventricular outflow tract” in the human heart. Therefore neither the AV node nor the His bundle are associated with atrial septum, which correlates with the fossa ovalis, and in the human heart is two centimeters removed from these structures. 10: Fig They also considered 1) that the socalled left-sided His bundle catheter, placed in the pocket of the posterior aortic cusp3, is located on the left side of the septum, and 2) that His bundle potentials are recorded here. However the posterior aortic pocket is attached to the right atrium at the level of the “medial atrial wall” and the “atrioaortic septum, and not atrial septum; and the so-called His potential is likely from the AV node. A full report on these associations in human heart is in preparation. These details suggest that a clear understanding of AVNRT will have to take into account the true anatomy.