Atrial activation during chronic atrial fibrillation in patients with isolated mitral valve disease
Atrial activation during chronic atrial fibrillation in patients with isolated mitral valve disease
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DOI：
10.1016/0003-4975(95)00824-1
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发表时间：
1996-01-01
影响因子：
4.6
通讯作者：
Shoji, T
中科院分区：
文献类型：
--
作者：
Harada, A;Sasaki, K;Shoji, T
背景资料。为了研究心房激动序列的特征，研制了一套计算机化的32道标测系统。该系统能够显示连续的心房图，为快速、动态地验证心房颤动的激活顺序提供了手段。应用该系统对10例单纯性二尖瓣手术的慢性房颤患者进行了术中心房激动标测。10例患者均有规律的、重复的起搏(周期为131~228毫秒)均起源于左心房。在观察期内，2例患者左心房交替出现两种重复激活模式，1例交替出现三种激活模式。与左心房的重复激活相比，右心房的激活序列极其复杂和混乱。在10例患者中，有7例在观察期内未出现相同的右心房激动模式。在2例患者中，右心房偶有重复激活的旋转，但激活模式立即恶化为复杂和混乱的模式。在1例患者中，右心房低位外侧出现重复激活。由于我们的标测技术受到可用心房电极数量的限制，在本研究中不能显示离散的折返回路或异位病灶。然而，慢性心房颤动时的激活序列提示：(1)大多数患者的左房可作为心房颤动的电驱动腔；(2)不同患者的心房激动模式不同。计算机化的术中标测应指导外科医生确定适当的手术方法，并为二尖瓣病变相关的慢性心房颤动的手术提供便利。
Background. A computerized 32-channel mapping system has been developed to investigate the characteristics of the atrial activation sequence. The system is capable of displaying sequential atrial maps and provides a rapid and dynamic means of verifying the activation sequence of atrial fibrillation.Methods. Using this system, we performed intraoperative atrial activation mapping in 10 patients with chronic atrial fibrillation who were undergoing isolated mitral valve operations.Results. Regular and repetitive activation (cycle length ranged from 131 to 228 milliseconds) originated in the left atrium in all 10 patients. Two patterns of repetitive activation in 2 patients and three patterns in 1 patient appeared alternately during the observation period in the left atrium. In contrast to the repetitive activation in the left atrium, the activation sequence of the right atrium was extremely complex and chaotic. In 7 of the 10 patients, the same pattern of right atrial activation was never repeated during the observation period. In 2 patients, revolution of repetitive activation in the right atrium sporadically appeared, but the pattern of activation immediately deteriorated to a complex and chaotic pattern. In 1 patient, repetitive activation emerged from the low lateral portion of the right atrium. Because our mapping technique was limited by the number of available atrial electrodes, discrete reentrant circuits or ectopic foci could not be demonstrated in the present study. However, the activation sequences during chronic atrial fibrillation suggested that (1) the left atrium would act as an electrical driving chamber for atrial fibrillation in the majority of the patients and (2) atrial activation patterns are different in each case.Conclusions. Computerized intraoperative mapping should guide surgeons in determining the appropriate surgical procedure and facilitate operation for chronic atrial fibrillation associated with mitral valve disease.