Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram.
Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram.
复制标题
犬心包炎模型中心房扑动期间的心房激活序列及其对心电图扑动波极性的影响。
DOI：
10.1016/s0735-1097(10)80124-x
复制
发表时间：
1991
影响因子：
24
通讯作者：
Waldo,AL
中科院分区：
文献类型：
--
作者：
Okumura,K;Plumb,VJ;Pagé,PL;Waldo,AL
研究人员对 30 只患无菌性心包炎的杂种狗在清醒和开胸状态下诱发的稳定心房扑动进行了研究。在意识状态研究期间，诱发的心房扑动（平均周期长度 128 ± 15 毫秒）始终持续 >15 分钟且稳定。心电图 (ECG) 导联 II 中注意到三种类型的扑动波极性：16 只狗为正，3 只为负，11 只为平或轻微正。开胸状态下心房扑动期间的顺序位点心房标测（平均周期长度 133 ± 18 ms）显示右心房顺时针（18 只狗）或逆时针（12 只狗）马戏团运动。在 30 只狗中，有 19 只的马戏运动显然不需要任何自然存在的解剖障碍； 11、上腔静脉口可能也受累。在心房扑动期间从折返回路的中心记录双电位，并从折返波前的枢轴点记录分段电图。心电图导联 II 中的正扑动波（12 只狗逆时针马戏团运动）与巴赫曼束区域（与后下左心房相比）的早期激活相关，并且左心房主要在上下方向激活。与巴赫曼束相比，负扑动与后下左心房的早期激活相关，并且与左心房的相当一部分在下上方向上的激活有关。平坦或轻微正向的扑动波（18 个顺时针马戏团运动中的 14 个）与来自这两个部位的两个波前几乎同时激活左心房有关。 总之，该狗模型中的心房扑动是由于右心房的马戏团运动引起的，其中心不一定需要解剖障碍。虽然心房扑动是由右心房的马戏团运动产生的，但心电图中的扑动波极性主要由左心房的激活序列决定。
Stable atrial flutter induced in both conscious and open chest states was studied in 30 mongrel dogs after production of sterile pericarditis. During the conscious state studies, induced atrial flutter (mean cycle length 128 ± 15 ms) was always sustained >15 min and was stable. Three types of flutter wave polarity were noted in electrocardiogram (ECG) lead II: positive in 16 dogs, negative in 3 and flat or slightly positive in 11.Sequential site atrial mapping during atrial flutter (mean cycle length 133 ± 18 ms) in the open chest state showed either clockwise (18 dogs) or counterclockwise (12 dogs) circus movement in the right atrium. In 19 of 30 dogs, the circus movement clearly did not require any naturally existing anatomic obstacle; in 11, the orifice of the superior vena cava probably was also involved. Double potentials were recorded from the center of the reentrant circuit during atrial flutter, and fractionated electrograms were recorded from a pivot point of the reentrant wave front. A positive flutter wave in ECG lead II (12 dogs with counterclockwise circus movement) was associated with early activation of the Bachmann's bundle region compared with the posteroinferior left atrium and activation of the left atrium mainly in a superoinferior direction. A negative flutter was associated with the early activation of the posteroinferior left atrium compared with Bachmann's bundle and activation of a considerable portion of the left atrium in an inferosuperior direction. A flat or slightly positive flutter wave (14 of 18 with clockwise circus movement) was associated with activation of the left atrium almost simultaneously by two wave fronts coming from both these sites.In conclusion, atrial flutter in this dog model is due to circus movement in the right atrium, the center of which does not necessarily require an anatomic obstacle. Although atrial flutter is generated by circus movement in the right atrium, the flutter wave polarity in the ECG is determined primarily by the activation sequence of the left atrium.