Electrophysiological and electroanatomic characterization of the atria in sinus node disease - Evidence of diffuse atrial remodeling
Electrophysiological and electroanatomic characterization of the atria in sinus node disease - Evidence of diffuse atrial remodeling
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DOI：
10.1161/01.cir.0000121734.47409.aa
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发表时间：
2004-03-30
期刊：
影响因子：
37.8
通讯作者：
Kalman, JM
中科院分区：
文献类型：
--
作者：
Sanders, P;Morton, JB;Kalman, JM
背景 - 正常的窦性起搏器复合体是右心房内的广泛结构。我们假设患有窦房结疾病 (SND) 的患者会有弥漫性心房异常的证据。方法和结果 - 对 16 名有症状的 SND 患者和 16 名年龄匹配的对照进行了研究。评估以下内容：高侧右心房和低侧右心房 (RA)、高位间隔 RA 和远端冠状窦 (CS) 的有效不应期 (ERP)；沿 CS 和外侧 RA 的传导时间； P波持续时间；和终嵴传导。进行电解剖测绘以定义窦房结复合体并确定区域传导速度、双电位、分段电图、区域电压和电静默区域。 SND 患者的所有右心房部位的心房 ERP 均显着增加，沿外侧 RA 和 CS 的心房传导时间增加，P 波持续时间延长，沿终嵴的双电位数量和持续时间增加。电解剖图表明，SND 中的窦房结复合体通常是单中心的，位于最大残余电压幅值处的低终嵴。存在显着的局部传导减慢，伴有双电位和与低电压和电静默（或疤痕）区域相关的分割。结论 - SND 与弥漫性心房重塑相关，其特征是结构变化、传导异常和右心房不应性增加。窦性起搏器活动的性质发生了变化，失去了正常的多中心激活模式，起搏器复合体尾部移位，以及传导阻滞线周围的异常和迂回传导。
Background - The normal sinus pacemaker complex is an extensive structure within the right atrium. We hypothesized that patients with sinus node disease (SND) would have evidence of diffuse atrial abnormalities.Methods and Results - Sixteen patients with symptomatic SND and 16 age-matched controls were studied. The following were evaluated: effective refractory periods (ERPs) from the high and low lateral right atrium (RA), high septal RA, and distal coronary sinus (CS); conduction time along the CS and lateral RA; P-wave duration; and conduction at the crista terminalis. Electroanatomic mapping was performed to define the sinus node complex and determine regional conduction velocity, double potentials, fractionated electrograms, regional voltage, and areas of electrical silence. Patients with SND demonstrated significant increase in atrial ERP at all right atrial sites, increased atrial conduction time along the lateral RA and CS, prolongation of the P-wave duration, and greater number and duration of double potentials along the crista terminalis. Electroanatomic mapping demonstrated the sinus node complex in SND to be more often unicentric, localized to the low crista terminalis at the site of the largest residual voltage amplitude. There was significant regional conduction slowing with double potentials and fractionation associated with areas of low voltage and electrical silence (or scar).Conclusions - SND is associated with diffuse atrial remodeling characterized by structural change, conduction abnormalities, and increased right atrial refractoriness. There was a change in the nature of sinus pacemaker activity with loss of the normal multicentric pattern of activation, caudal shift of the pacemaker complex, and abnormal and circuitous conduction around lines of conduction block.