Prevention of postsurgical atrial tachycardia with a modified right atrial free wall incision.
Prevention of postsurgical atrial tachycardia with a modified right atrial free wall incision.
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DOI：
10.1016/j.hrthm.2015.03.026
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发表时间：
2015-07
期刊：
影响因子：
5.5
通讯作者：
Gang Yang;X. Du;Buqing Ni;Hongwu Chen;Rundi Qi;Cheng Cai;Yin Fang;Bing Yang;Weizhu Ju;Fengxiang Zhang;Mingfang Li;K. Gu;Y. Shao;Minglong Chen
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文献类型：
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作者：
Gang Yang;X. Du;Buqing Ni;Hongwu Chen;Rundi Qi;Cheng Cai;Yin Fang;Bing Yang;Weizhu Ju;Fengxiang Zhang;Mingfang Li;K. Gu;Y. Shao;Minglong Chen
大折返性房性心动过速（PS-MAT）与心房切开术有关;但是，在此情况下，本研究的目的是研究右心房切开术切口致心律失常的电生理和组织学基础，以及将切口线延伸到三尖瓣环（TA）和下腔静脉（IVC）的改良心房切开术是否能预防PS-1。方法对30只成年猪右房切开术后8周，根据切口距TA或IVC的距离，观察其房性心律失常的诱发、电生理和组织学特征（A、B、C组：分别为宽、窄、封闭走廊，D组：无切口假手术;除B组n = 12外，每组n = 6）。结果在宽通道组和窄通道组中诱导并定位了持续的PS-MAT（A组，1/6 [16.7%] vs B组，5/12 [41.7%]），但在封闭通道（C）或假手术（D）组中没有（P= 0.087）。起搏周期长度递减20 ms（从350到270 ms），对于5和10 mm，心房切开术到TA通道20 mm以上的平均传导时间分别为29.2 ± 2.2、31.0 ± 4.2、26.0 ± 1.9和17.0 ± 1.4 ms（两组B）、15 mm（A组）和假切口（P= 0.017）。传导特性与组织学发现相关：走廊越宽，其组织越健康。在C组（改良心房切开术），两个通道被致密的瘢痕完全conductoblock.ConclusionAtriotomy走廊宽度决定的传导特性，有助于mammogenicity取代。延伸至TA和IVC的改良右心房切开术可预防PS-MAT。
BackgroundMost postsurgical macroreentry atrial tachycardias (PS-MATs) are atriotomy related; however, underlying mechanisms and prevention remain undefined.ObjectiveThe purpose of the present study was to investigate the electrophysiological and histologic bases of right atriotomy incision arrhythmogenicity and whether a modified atriotomy that extends the incisional line to the tricuspid annulus (TA) and inferior vena cava (IVC) prevents PS-MAT.MethodsAtrial arrhythmia induction and electrophysiological and histologic characteristics were studied 8 weeks after right atriotomy in 30 adult swine according to incision distance to TA or IVC (groups A, B, and C: broad, narrow, and closed corridors, respectively; group D, no-incision sham; n = 6 per group, except n = 12 for group B).ResultsSustained PS-MATs were induced and mapped in the broad- and narrow-corridor groups (A, 1 of 6 [16.7%] vs B, 5 of 12 [41.7%]) but not in the closed-corridor (C) or sham (D) groups (P= .087). With 20-ms pacing cycle–length decrements (from 350 to 270 ms), mean conduction time over 20 mm at the atriotomy-to-TA corridor was 29.2 ± 2.2, 31.0 ± 4.2, 26.0 ± 1.9, and 17.0 ± 1.4 ms for 5 and 10 mm (both group B), 15 mm (group A), and sham incision (P= .017), respectively. Conduction properties correlated with histologic findings: the wider the corridor, the healthier its tissue. In group C (modified atriotomy), both corridors were replaced by dense scar with complete conduction block.ConclusionAtriotomy corridor width determines conduction properties and contributes to arrhythmogenicity. A modified right atriotomy that extends to the TA and IVC prevents PS-MAT.