SPREAD OF EXCITATION FROM ATRIUM INTO THORACIC VEINS IN HUMAN BEINGS AND DOGS
SPREAD OF EXCITATION FROM ATRIUM INTO THORACIC VEINS IN HUMAN BEINGS AND DOGS
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DOI：
10.1016/0002-9149(72)90009-4
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发表时间：
1972-01-01
影响因子：
2.8
通讯作者：
JEWETT, PH
中科院分区：
文献类型：
--
作者：
SPACH, MS;BARR, RC;JEWETT, PH
心房和胸静脉标测显示，心房最早活动部位沿终沟由低至高沿着排列，心肌延伸至除下腔静脉外的所有胸静脉2 ~ 4cm。为了了解心外膜波的波形，在开胸和闭胸犬上进行了实验。犬的心房肌向上伸入上级腔静脉的程度远大于人的心房肌伸入该血管的程度。人奇静脉无心电活动，绝大多数波形的形状（叠加在延长的负曲线上的快速偏转）是由于心房中的大激发波和胸静脉中的较小激发波的叠加效应。超微结构研究表明，心房肌的胸部静脉的狗。人类胚胎的心肌延伸到胸静脉的程度远远大于儿童和成人。在一位左上级腔静脉持续存在的病人中，心脏兴奋进展到心脏上方远至无名静脉交界处，心脏可以从这个位置起搏。结果表明，心房扑动的刘易斯理论，即腔静脉提出了一个障碍，周围的兴奋波的进展是站不住脚的，因为波前在静脉肌肉中传播的方式，迅速使组织难治性的合并和碰撞波。
Atrial and thoracic vein mapping in patients showed that the earliest site of atrial activity ranged from a low to high position along the sulcus terminalis and that cardiac muscle extended for 2 to 4 cm into all of the thoracic veins except the inferior vena cava. To understand the epicardial wave forms, experiments were carried out in open and closed chest dogs. Atrial muscle extended superiorly into the superior vena cava of the dog to a far greater degree than it extended into this vessel in man. In some dogs, cardiac muscle in the azygous vein extended to the spine, and at this site the heart could be paced; no cardiac electrical activity occurred in the azygous vein of man. The shape of most wave forms (a rapid deflection superimposed on a prolonged negative curve) was due to a superposition of effect of a large excitation wave in the atrium and a smaller excitation wave in the thoracic veins. Ultrastructural studies revealed atrial muscle in the thoracic veins of the dog. The extension of cardiac muscle into the thoracic veins of human embryos was far greater than that found in children and adults. In a patient with a persistent left superior vena cava, cardiac excitation progressed far above the heart to the junction with the innominate vein, a position from which the heart could be paced. The results suggest that the Lewis theory of atrial flutter—that is, that the venae cavae present an obstacle around which excitation waves progress—is untenable since wave fronts propagate in the venous muscle in a manner that quickly renders the tissue refractory by the merging and collision of waves.