Pulmonary vein reentry - Properties and size matter: Insights from a computational analysis
Pulmonary vein reentry - Properties and size matter: Insights from a computational analysis
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DOI：
10.1016/j.hrthm.2007.08.017
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发表时间：
2007-12-01
期刊：
影响因子：
5.5
通讯作者：
Fenton, Flavio H.
中科院分区：
文献类型：
--
作者：
Cherry, ELizabeth M.;Ehrlich, Joachim R.;Fenton, Flavio H.
背景技术肺静脉（PV）消融在心房颤动（AF）治疗中发挥着重要作用，但对PV致心律失常的机制理解有限。有人提出快速局灶激活，但一些证据表明潜在的折返。目的本研究旨在评估PV的电生理特性如何使其成为折返部位，并具体分析PV尺寸和耦合特性的作用。方法设计用于有效再现电生理行为的计算机模型适合犬左心房（LA）和PV的动作电位。为了评估结构和功能性心律失常的决定因素，将不同长度和周长的理想化PV附着到LA组织，并模拟额外刺激后5秒的活动。结果PV折返活动主要取决于静脉大小和耦合特性。随着横向和纵向连接的累积去除，对于长 1-3 厘米、周长 1-2 厘米的静脉，可以观察到持续（n = 23）或非持续（n = 93）折返（687 次模拟）。持续折返的发生率随着 PV 长度的增加而增加（1 厘米为 8%，2 厘米和 3 厘米分别为 22% 和 31%；P
BACKGROUND Pulmonary vein (PV) ablation plays an important role in atrial fibrillation (AF) therapy but suffers from a limited mechanistic understanding of PV arrhythmogenicity. Rapid focal activation has been suggested, but some evidence points to underlying reentry.OBJECTIVE This study was performed to evaluate how the electrophysiological properties of PVs may make them a site for reentry and to analyze specifically the roles of PV dimensions and coupling properties.METHODS A computer model designed to efficiently reproduce electrophysiological behaviors was fit to action potentials from canine left atria (LA) and PVs. To assess structural and functional arrhythmogenic determinants, an idealized PV of varying length and circumference was attached to LA tissue, and 5 seconds of activity after extrastimulation were simulated.RESULTS PV reentrant activity depended critically on vein size and coupling properties. With cumulative removal of transverse and longitudinal connections, sustained (n = 23) or nonsustained (n = 93) reentries could be observed (687 simulations) for veins 1-3 cm Long and 1-2 cm in circumference. The prevalence of sustained reentry increased with PV length (8% for 1 cm vs. 22% and 31% for 2 and 3 cm, respectively; P