Role of the His-Purkinje system in the genesis of cardiac arrhythmia
Role of the His-Purkinje system in the genesis of cardiac arrhythmia
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DOI：
10.1016/j.hrthm.2009.03.011
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发表时间：
2009-07-01
期刊：
影响因子：
5.5
通讯作者：
Scheinman, Melvin M.
中科院分区：
文献类型：
--
作者：
Scheinman, Melvin M.
尽管大量早期研究集中在浦肯野纤维的组织学和动作电位特征上，但直到最近才发现希氏-浦肯野系统在心律失常的发生中起主要作用。左心室传导系统的解剖复杂性似乎有利于患病和健康心脏的折返性心律失常。右束和左束之间以及左心室束之间的大折返回路适合通过消融技术来治愈。同样，在没有结构性心脏病的个体中发生的束状心动过速似乎涉及束和相关股（假腱？）之间的大折返回路。令人兴奋的新发现强烈表明浦肯野系统是短耦合室性早搏和儿茶酚胺能多形性室性心动过速患者室性心律失常的原因。组氨酸-浦肯野系统在心室颤动的发生和维持中的作用是生育研究的另一个前沿领域。多种心律失常似乎都涉及心室专门传导系统，并且可能适合消融治疗。
Although a plethora of earlier studies focused on the histology and action potential characteristics of Purkinje fibers, only recently has the His-Purkinje system been found to play a major rote in the genesis of cardiac arrhythmias. The anatomic complexity of the Left ventricular conduction system appears to favor reentrant arrhythmias in both diseased and healthy hearts. Macroreentrant circuits between the right and left bundles as well as between the left ventricular fascicles are amenable to cure by ablative techniques. Similarly, fascicular tachycardias occurring in individuals without structural cardiac disease appear to involve macroreentrant circuits between fascicles and associated strands (false tendons?). Exciting newer discoveries strongly implicate the Purkinje system as the cause of ventricular arrhythmias in patients with short-coupled premature ventricular complexes and in those with catecholaminergic polymorphous ventricular tachycardia. The role of the His-Purkinje system in the genesis and maintenance of ventricular fibrillation is yet another frontier for fertile investigation. A rich variety of cardiac arrhythmias appears to involve the ventricular specialized conduction system and may be amenable to ablative therapy.