High resolution mapping of Koch's triangle using sixty electrodes in humans with atrioventricular junctional (AV nodal) reentrant tachycardia.
High resolution mapping of Koch's triangle using sixty electrodes in humans with atrioventricular junctional (AV nodal) reentrant tachycardia.
复制标题
使用 60 个电极对患有房室交界（AV 结）折返性心动过速的人进行科赫三角的高分辨率绘图。
作者：
M. McGuire;J. Bourke;M. Robotin;David C. Johnson;W. Meldrum;G. Nunn;J. Uther;D. Ross
背景
最近的证据表明房室交界处折返性心动过速（AVJRT）使用涉及房室结（AV）、房室结连接和结周心房组织的折返回路。电描记图形态已被用于将射频能量定向输送到“慢通路”部位，这是折返回路的一个组成部分。本研究的目的是精确定位AVJRT中涉及的房室结连接的部位，并检查Koch三角上的心房电图形态及其空间分布。
方法和结果
应用60点斑块电极和计算机标测系统对13例患者的Koch三角和近端冠状窦进行了电激活检查。在窦性心律（n = 12）、左心房起搏（n = 8）、心室起搏（n = 12）和AVJRT（n = 12）期间进行记录。在窦性心律期间，电激活从前利姆布斯的方向接近Koch三角和房室结，在激活三角的后部之前激活三角的前部。窦性心律时，64%的患者在Koch三角内发现慢传导区。前向性快径传导时Koch三角的心房激动模式与前向性慢径传导时的心房激动模式相似。心室起搏和前（典型）AVJRT期间的逆行快径传导导致房室结-希氏束交界处附近Koch三角顶点的最早心房激动。在个体患者中，心室起搏期间前AVJRT和逆行快径传导的最早心房激动部位相似。心室起搏期间和后部（不常见或非典型）AVJRT期间的逆行慢径传导导致冠状窦口附近房室结后部的最早心房激动。这个后部或“慢路径”出口部位距离希氏束15 +/- 4 mm。在个体患者中，心室起搏期间后AVJRT和逆行慢径传导的最早心房激动部位相似。在1例患者中，在AVJRT期间通过单独的慢径路发生了顺行和逆行传导：在所有病例中，在冠状窦口附近和Koch三角的后部观察到具有两个或多个组件的复杂心房电图。根据电描记图第二分量的快速性，将其分为低频或高频电位。5例（100%）心房逆行慢径传导时最早兴奋部位出现低频电位，4例（80%）出现高频电位。然而，慢电位和高频电位都可以在距离最早心房兴奋部位16 mm的部位找到。
结论
至少存在两组不同的房室结连接。前房室结折返性心动过速时心房最早激动的部位与心室起搏时快径传导的部位相似。该部位靠近希氏结-房室结交界处。后房室结折返性心动过速时最早心房激动的部位与心室起搏时慢径传导的部位相似。该部位靠近冠状窦口，距离希氏束约15 mm。在某些患者中，顺行性慢径似乎与逆行性慢径不同。双心房电图是逆行慢径传导过程中最早心房兴奋部位的不精确指南。
BACKGROUND
Recent evidence suggests that atrioventricular junctional reentrant tachycardia (AVJRT) uses a reentrant circuit that involves the atrioventricular (AV) node, the atrionodal connections, and perinodal atrial tissue. Electrogram morphology has been used to target the delivery of radiofrequency energy to the site of the "slow pathway," a component of this reentrant circuit. The aim of this study was to localize precisely the sites of atrionodal connections involved in AVJRT and to examine atrial electrogram morphologies and their spatial distribution over Koch's triangle.
METHODS AND RESULTS
Electrical activation of Koch's triangle and the proximal coronary sinus was examined in 13 patients using a 60-point plaque electrode and computerized mapping system. Recordings were made during sinus rhythm (n = 12), left atrial pacing (n = 8), ventricular pacing (n = 12), and AVJRT (n = 12). During sinus rhythm electrical activation approached Koch's triangle and the AV node from the direction of the anterior limbus, activating the anterior part of the triangle before the posterior part. A zone of slow conduction during sinus rhythm was found within Koch's triangle in 64% of patients. The pattern of atrial activation in Koch's triangle during anterograde fast pathway conduction was similar to that seen during anterograde slow pathway conduction. Retrograde fast pathway conduction during ventricular pacing and during anterior (typical) AVJRT caused earliest atrial activation at the apex of Koch's triangle near the AV node-His bundle junction. In individual patients the site of earliest atrial activation was similar for both anterior AVJRT and retrograde fast pathway conduction during ventricular pacing. Retrograde slow pathway conduction during ventricular pacing and during posterior (uncommon or atypical) AVJRT caused earliest atrial activation posterior to the AV node near the orifice of the coronary sinus. This posterior or "slow pathway" exit site was 15 +/- 4 mm from the His bundle. In individual patients the site of earliest atrial activation was similar for both posterior AVJRT and retrograde slow pathway conduction during ventricular pacing. In one patient anterograde and retrograde conduction occurred via separate slow pathways during AVJRT: Complex atrial electrograms with two or more components were observed near the coronary sinus orifice and in the posterior part of Koch's triangle in all cases. These were categorized as either low or high frequency potentials according to the rapidity of the second component of the electrogram. Low frequency potentials were present at the site of earliest atrial excitation during retrograde slow pathway conduction in 5 of 5 cases (100%) and high frequency potentials in 4 of 5 cases (80%). However, both slow and high frequency potentials could be found at sites up to 16 mm from the site of earliest atrial excitation.
CONCLUSIONS
At least two distinct groups of atrionodal connections exist. The site of earliest atrial activation during anterior AVJRT is similar to that of fast pathway conduction during ventricular pacing. This site is close to the His bundle-AV node junction. The site of earliest atrial activation during posterior AVJRT is similar to that of slow pathway conduction during ventricular pacing. This site is near the coronary sinus orifice, approximately 15 mm from the His bundle. The anterograde slow pathway appears to be different from the retrograde slow pathway in some patients. Double atrial electrograms are an imprecise guide to the site of earliest atrial excitation during retrograde slow pathway conduction.
人类房间隔的计算机化激活序列图。
DOI：
10.1016/0003-4975(90)90144-u
发表时间：
1990
期刊：
The Annals of thoracic surgery
影响因子：
--
作者：
Chang,BC;Schuessler,RB;Stone,CM;Branham,BH;Canavan,TE;Boineau,JP;Cain,ME;Corr,PB;Cox,JL
通讯作者：
Cox,JL