Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter.
Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter.
复制标题
演示常见类型心房扑动的大折返和手术治疗的可行性。
DOI：
10.1016/0002-9149(86)90840-4
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
S. Milstein
中科院分区：
文献类型：
--
作者：
G. Klein;G. Guiraudon;A. Sharma;S. Milstein
两名患者描述谁复发和长期房扑的共同类型，并提到电生理测试和手术治疗。在这两名患者中，心房扑动可以通过程控刺激启动和终止。心房内膜标测显示冠状窦口处房扑期间最早的激动，活动分别进行到低房间隔、高侧右心房和低右心房。当房间隔区域为难治性晚期房扑时，来自高位右心房的程控房性期外收缩与期外刺激的过早发生成比例，同时维持从低到高的激动序列。术中，心外膜心房标测显示一个大的右心房折返回路，始于后间隔区，并在返回其起点之前向上和侧向穿过右心房游离壁。在三尖瓣环与下腔静脉口和近端冠状窦口之间的右心房下部组织中，分别观察到回路的最西侧部分和心房扑动时传导相对较慢的部分。在两名患者中，冠状窦口周围和周围心房壁的冷冻消融在短期随访中防止了复发性房扑，尽管其中1名患者需要抗心律失常治疗术后房颤。
Two patients are described who had recurrent and long-standing atrial flutter of the common type and were referred for electrophysiologic testing and surgical management. In both patients, atrial flutter could be initiated and terminated by programmed stimulation. Atrial endocardial mapping showed earliest activation during flutter at the orifice of the coronary sinus, with activity proceeding to the low atrial septum, high lateral right atrium and low right atrium, respectively. Programmed atrial extrasystoles from the high right atrium at a time when the atrial septal region was refractory advanced atrial flutter in proportion to prematurity of the extrastimulus, while maintaining the low to high activation sequence. Intraoperatively, epicardial atrial mapping revealed a large right atrial reentrant circuit beginning in the posteroseptal region and proceeding superiorly and laterally through the right atrial free wall before returning to its starting point. The narrowest part of the circuit and that showing relatively slow conduction during atrial flutter was observed in the low right atrial tissue between the tricuspid valve ring and the orifices of the inferior vena cava and proximal coronary sinus, respectively. Cryosurgical ablation around the orifice of the coronary sinus and surrounding atrial wail has prevented recurrent atrial flutter over short term follow-up in both patients, although 1 of the patients has required antiarrhythmic therapy for postoperative atrial fibrillation.