Biatrial Activation in Isthmus-Dependent Atrial Flutter
Biatrial Activation in Isthmus-Dependent Atrial Flutter
复制标题
峡部依赖性心房扑动中的双心房激活
作者：
L. Rodríguez;C. Timmermans;A. Nabar;L. Hofstra;H. Wellens
背景-本研究的目的是确定峡部依赖型心房扑动(AFL)的双房激活模式，以了解功能性心房间联系和左房(LA)的激活模式。方法和结果：在10例右房峡部消融术中，采用双房电解剖标测系统，逆时针(n=7)或顺时针(n=3)行双房激活。房间隔环绕瓣膜，缓慢传播(0.5±0.2m/S)通过峡部。LA由两个波前激活，在上、中、下间隔分别有不同的突破。LA的激活与AFL周期长度的50±16%重叠。逆时针AFL中，至少有一个突破口位于下间隔。扑动波离开峡部后立即开始激活LA，所有患者均指向下方，与房间隔的激活同步。顺时针AFL患者的间隔突破位置各不相同。LA激活方向为上下者2例，下下者1例。结论：峡部依赖性AFL的环路完全位于右心房。LA的激活是一个旁观者，在跨间隔传导穿过下冠状静脉窦-LA连接、Bachmann束和/或卵圆窝后激活。
Background—The aim of this study was to determine the biatrial activation pattern in isthmus-dependent atrial flutter (AFL) to understand the functional interatrial connections and the activation pattern of the left atrium (LA). Methods and Results—Biatrial activation was performed, using an electroanatomic mapping system, in 10 patients undergoing right atrial isthmus ablation for counterclockwise (n=7) or clockwise (n=3) AFL. The AFL circuit was peritricuspid and propagated slowly (0.5±0.2 m/s) through the isthmus. LA was activated by two wave fronts, with discrete breakthroughs in the superior, mid, or inferior atrial septum. The activation of LA overlapped 50±16% of the AFL cycle length. In counterclockwise AFL, at least one breakthrough was located in the inferior atrial septum. LA activation began immediately after the exit of the flutter wave from the isthmus and was directed inferosuperiorly in all patients, being synchronous with the atrial septal activation. The septal breakthroughs in patients with clockwise AFL were variably located. The direction of LA activation was superoinferior in 2 and inferosuperior in 1 patient. Conclusions—The circuit of isthmus-dependent AFL was entirely in the right atrium. LA activation was a bystander and followed trans-septal conduction across the inferior coronary sinus-LA connection, Bachmann’s bundle, and/or fossa ovalis.
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