Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias
Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias
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DOI：
10.1152/ajpheart.00228.2012
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发表时间：
2012-11-01
影响因子：
4.8
通讯作者：
Ravelli, Flavia
中科院分区：
文献类型：
--
作者：
Mase, Michela;Glass, Leon;Ravelli, Flavia
张文良，张文良，张文良.结恢复、双径路生理学和隐蔽传导决定了人类房性快速性心律失常的复杂AV动力学。Am J Physiol Heart Circ Physiol 303：H1219-H1228，2012年。首次发表于2012年9月14日; doi：10.1152/ajpheart.00228.2012.-人类房性快速性心律失常期间复杂室性心律的起源尚未完全了解。为了阐明房室（AV）传导对规律性高频率心房激动的动力学反应，分析了10例患者的29次自发性或起搏诱导的房扑（AFL）发作，涵盖了广泛的心房率（周期长度从145到270 ms）。通过对心房和心室激动系列应用击发序列和替代数据分析来识别AV模式，而使用具有差分方程AV节点模型的模块化模拟将模式与特定节点属性相关联。高心房率时房室结反应的特征为：1）心房周期缩短时传导比降低的房室模式（从236.3 +/- 32.4到172.6 +/- 17.8 ms）（传导比从0.34 +/- 0.12到0.23 +/- 0.06; P < 0.01）; 2）高阶交替文氏节律的出现，例如6：2、10：2和12：1。2、与大幅度心室间隔振荡有关（407.7 ± 150.4 ms）;以及3）在高级块时图案稳定性的恶化，稳定型的百分比从64.3 ± 35.2%下降到28.3 ± 34.5%（P < 0.01）。模拟表明，这些模式起源于结恢复，双通道生理和隐蔽传导的综合作用。这些结果表明，固有的节点属性可能会占频谱的房室传导阻滞模式发生在规则的房性快速性心律失常。在不同的AFL形式的房室结功能的表征构成了一个中间步骤，了解复杂的心室节律在心房颤动。
Mase M, Glass L, Disertori M, Ravelli F. Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias. Am J Physiol Heart Circ Physiol 303: H1219-H1228, 2012. First published September 14, 2012; doi: 10.1152/ajpheart.00228.2012.-The genesis of complex ventricular rhythms during atrial tachyarrhythmias in humans is not fully understood. To clarify the dynamics of atrioventricular (AV) conduction in response to a regular high-rate atrial activation, 29 episodes of spontaneous or pacing-induced atrial flutter (AFL), covering a wide range of atrial rates (cycle lengths from 145 to 270 ms), were analyzed in 10 patients. AV patterns were identified by applying firing sequence and surrogate data analysis to atrial and ventricular activation series, whereas modular simulation with a difference-equation AV node model was used to correlate the patterns with specific nodal properties. AV node response at high atrial rate was characterized by 1) AV patterns of decreasing conduction ratios at the shortening of atrial cycle length (from 236.3 +/- 32.4 to 172.6 +/- 17.8 ms) according to a Farey sequence ordering (conduction ratio from 0.34 +/- 0.12 to 0.23 +/- 0.06; P < 0.01); 2) the appearance of high-order alternating Wenckebach rhythms, such as 6: 2, 10: 2, and 12: 2, associated with ventricular interval oscillations of large amplitude (407.7 +/- 150.4 ms); and 3) the deterioration of pattern stability at advanced levels of block, with the percentage of stable patterns decreasing from 64.3 +/- 35.2% to 28.3 +/- 34.5% (P < 0.01). Simulations suggested these patterns to originate from the combined effect of nodal recovery, dual pathway physiology, and concealed conduction. These results indicate that intrinsic nodal properties may account for the wide spectrum of AV block patterns occurring during regular atrial tachyarrhythmias. The characterization of AV nodal function during different AFL forms constitutes an intermediate step toward the understanding of complex ventricular rhythms during atrial fibrillation.