THE SURGICAL-TREATMENT OF ATRIAL-FIBRILLATION .2. INTRAOPERATIVE ELECTROPHYSIOLOGIC MAPPING AND DESCRIPTION OF THE ELECTROPHYSIOLOGIC BASIS OF ATRIAL-FLUTTER AND ATRIAL-FIBRILLATION
THE SURGICAL-TREATMENT OF ATRIAL-FIBRILLATION .2. INTRAOPERATIVE ELECTROPHYSIOLOGIC MAPPING AND DESCRIPTION OF THE ELECTROPHYSIOLOGIC BASIS OF ATRIAL-FLUTTER AND ATRIAL-FIBRILLATION
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DOI：
10.1016/s0022-5223(19)36723-6
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发表时间：
1991-03-01
影响因子：
6
通讯作者：
BOINEAU, JP
中科院分区：
文献类型：
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作者：
COX, JL;CANAVAN, TE;BOINEAU, JP
为了系统地研究心房颤动，我们建立了一个临床相关的心房颤动实验模型。在25只犬中，在不打开心包的情况下，通过手术创建慢性二尖瓣返流。在慢性二尖瓣返流几个月后，心房变大，并可通过标准程控电刺激技术诱导持续性房颤。同时记录208个双极电极在心房颤动时的心房等电位激动图。在一项平行研究中，使用单独的160通道术中标测系统对接受手术矫正Wolff-Parkinson-白色综合征的阵发性房颤患者进行了人体房颤标测。犬激动序列图显示了一系列心律异常，从简单的心房扑动到复杂的心房颤动。他们还表明，心房肌内的大折返回路是整个心律失常的原因。在人类房颤期间也记录了心房折返。所有患者在两个心房的双向传导阻滞区域周围都有不均匀的传导，导致多个离散的波前。此外，6例患者在右心房有一个单一的折返回路，其中激活波阵面的双向阻滞发生在沿着腔静脉之间的终沟。所有患者左房均表现为多个波前和传导阻滞，但未检测到左房折返。实验研究和临床研究均表明，房颤时出现多波前、不均匀传导、双向阻滞和大折返环路。大折返环的存在和微折返环或心房自律性证据的缺乏表明，心房颤动应服从手术消融。
Computerized mapping of atrial fibrillation was performed in animals and man. To study atrial fibrillation in a systematic manner, we developed a clinically relevant experimental model of atrial fibrillation. Chronic mitral regurgitation was created surgically in 25 dogs without opening the pericardium. After several months of chronic mitral regurgitation, the atria became enlarged and sustained atrial fibrillation could be induced by standard programmed electrical stimulation techniques. Computerized isochronous activation maps of the atria were recorded during atrial fibrillation from 208 bipolar electrodes simultaneously. In a parallel study, human atrial fibrillation was mapped with a separate 160-channel intraoperative mapping system in patients with paroxysmal atrial fibrillation who were undergoing surgical correction of the Wolff-Parkinson-White syndrome. The canine activation sequence maps demonstrated a spectrum of rhythm abnormalities ranging from simple atrial flutter to complex atrial fibrillation. They also showed that macroreentrant circuits within the atrial myocardium were responsible for the entire spectrum of arrhythmias. Atrial reentry was also documented during human atrial fibrillation. All patients had nonuniform conduction around regions of bidirectional block in both atria resulting in multiple discrete wave fronts. In addition, six patients had a single reentrant circuit in the right atrium in which bidirectional block of the activation wave front occurred along the sulcus terminalis between the venae cavae. The left atrium in all patients demonstrated multiple wave fronts and conduction block, but left atrial reentry could not be detected. Both the experimental study and the clinical study demonstrated that multiple wave fronts, nonuniform conduction, bidirectional block, and large (macroreentrant) reentrant circuits occur during atrial fibrillation. The presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation.