Atrial activation mapping in sinus rhythm in the clinical electrophysiology laboratory:: Observations during Bachmann's bundle block
Atrial activation mapping in sinus rhythm in the clinical electrophysiology laboratory:: Observations during Bachmann's bundle block
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DOI：
10.1046/j.1540-8167.2004.03403.x
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发表时间：
2004-05-01
影响因子：
2.7
通讯作者：
Schames, S
中科院分区：
文献类型：
--
作者：
Cosío, FG;Martín-Peñato, A;Schames, S
窦性心律的心内膜心房标测。前言：高后外侧右心房(RA)被认为是“窦房结区域”，但我们缺乏关于窦性心律时心内膜心房活动的信息。方法和结果：35例患者(21名男性)接受了RA标测(22.2+/-3.8分)，平均年龄为+/-16.4岁。在21例患者中，LA激活通过冠状静脉窦(CS)、右肺动脉和/或开放的椭圆形孔被标测(11.1+/-3.9点)。房性心律失常14例，Bachmann束传导阻滞3例。心内膜RA激动先于P波5例(-14+/-4.2ms)，符合P波11例，P波起搏后18例(16.7±-6.6ms)。从上腔静脉到下腔静脉，从外侧到间隔旁，零点的位置不同。在19名患者中，激活同时开始于相距大于或等于1厘米的2至5个点。RA活性多数下降，但3例起病较轻的患者出现前壁与间隔的碰撞。在21例患者中，15例以下行激活为主，12例终止于中段CS，1例终止于近段CS，2例在整个CS同时激活。在3例Bachmann束传导阻滞患者中，CS激活呈上升趋势，2例在LA顶部记录到双电位。结论：在稳定的窦性心律中，RA的激活可在不同区域或同时在大范围内开始，导致RA和LA的激活模式不同。左房激动以下降为主，但在巴赫曼束阻滞时呈上升状态，双电位提示左房顶端有一定的阻滞点。
Endocardial Atrial Mapping in Sinus Rhythm. Introduction: The high posterolateral right atrium (RA) is considered the "sinus node area," but we lack information on endocardial atrial activation in sinus rhythm. We studied RA and left atrial (LA) endocardial activation in the electrophysiology laboratory.Methods and Results: Thirty-five patients (21 men) aged 47+/-16.4 years (mean+/-SD) underwent RA mapping (22.2+/-3.8 points). In 21 patients, LA activation was mapped (11.1+/-3.9 points) through the coronary sinus (CS), right pulmonary artery, and/or a patent oval foramen. Fourteen patients had atrial arrhythmias, and 3 an ECG pattern of Bachmann's bundle block. Endocardial RA activation preceded P wave in 5 (-14+/-4.2 ms), coincided in 11, and followed P onset in 18 (16.7+/-6.6 ms). Location of the zero point varied from the superior vena cava to the low RA and from lateral to paraseptal RA. In 19 patients, activation started simultaneously in 2 to 5 points located greater than or equal to1 cm apart. RA activation was descending in most, but in 3 with low onset there was collision in the anterior and septal walls. In 15 of 21 patients, descending LA activation dominated, ending in the mid CS in 12, proximal CS in 1, and simultaneously throughout the CS in 2. In 3 with Bachmann's bundle block, CS activation was ascending and in 2 double potentials were recorded from the LA roof.Conclusion: During stable sinus rhythm, RA activation can start in different areas or simultaneously over large areas resulting in different activation patterns, both in the RA and the LA. LA activation is predominantly descending, but in Bachmann's bundle block it becomes ascending, and double potentials suggest a location of block in the LA roof.