Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method
Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method
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窦房结折返性心动过速的解剖学心动过速回路演示：使用夹带法进行分析
DOI：
10.1161/jaha.119.014472
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Yoshiya Orita
中科院分区：
文献类型：
--
作者：
H. Yamabe;Yoshiya Orita
背景：窦房结折返性心动过速(SANRT)的解剖心动过速回路尚不清楚。本研究旨在阐明SANRT的心动过速回路。方法与结果对15例SANRT患者进行折返回路的结内窦房结传导(I-SANC)检测。在确定心动过速时最早的心房激活点(EAAS-SANRT)后，从多个心房部位进行快速心房起搏，以确定显示EAAS-SANRT明显夹带和顺向俘获的起搏部位。然后，射频能量从EAAS-SANRT近端2 cm处开始向夹带起搏部位的方向传递，并逐渐向EAAS-SANRT方向推进，直到心动过速终止，以定位I-SANC入口。分别从冠状静脉窦远端(n=7)、后间隔高位右心房(n=2)、后间隔低位右心房(n=2)、前外侧低位右房(n=2)或冠状静脉窦口(n=2)起搏，顺向捕捉EAAS-SANRT。射频能量传输至距EAAS-SANRT 10.4±2.8 mm的I-SANC入口处，能量传输开始后立即终止心动过速(3.4±2.3秒)。消融成功的部位在窦性心律(窦性心律)时比消融前(12·8±4·5)mm比(7·2±3·1)mm更远(P<0·05)。结论SANRT的折返回路由位于不同解剖位置的I-SANC的入口和出口组成。SANRT被射频能量输送到I-SANC入口处消除，I-SANC入口处比I-SANC出口距离EAAS-窦口更远。
Background The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT. Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site (EAAS) during the tachycardia (EAAS‐SANRT), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS‐SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS‐SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS‐SANRT until tachycardia termination to localize the I‐SANC entrance. The EAAS‐SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐SANC, 10.4±2.8 mm away from the EAAS‐SANRT, terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm (EAAS‐sinus) than the EAAS‐SANRT (12.8±4.5 versus 7.2±3.1 mm; P<0.0001). Conclusions The reentry circuit of SANRT was composed of the entrance and exit of the I‐SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐SANC entrance, which was further from the EAAS‐sinus than I‐SANC exit.
影响因子：
24
作者：
Fedorov, Vadim V.;Glukhov, Alexey V.;Chang, Roger;Kostecki, Geran;Aferol, Hyuliya;Hucker, William J.;Wuskell, Joseph P.;Loew, Leslie M.;Schuessler, Richard B.;Moazami, Nader;Efimov, Igor R.
通讯作者：
Efimov, Igor R.
DOI：
10.1016/j.pbiomolbio.2015.12.011
发表时间：
2016-01
影响因子：
3.8
作者：
Csepe TA;Zhao J;Hansen BJ;Li N;Sul LV;Lim P;Wang Y;Simonetti OP;Kilic A;Mohler PJ;Janssen PM;Fedorov VV
通讯作者：
Fedorov VV