Detection of sequential activation of left atrium and coronary sinus musculature in the general population.
Detection of sequential activation of left atrium and coronary sinus musculature in the general population.
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DOI：
10.1016/j.joa.2016.02.003
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发表时间：
2016-12
影响因子：
2
通讯作者：
Kurabayashi M
中科院分区：
文献类型：
--
作者：
Ota M;Kaneko Y;Nakajima T;Irie T;Iijima T;Saito A;Kurabayashi M
脉冲在冠状窦（CS）肌肉组织（CSM）中的传播方向是房性快速性心律失常机制的重要组成部分。我们假设在一般人群中，CS中记录的左心房（LA）至CSM电描记图的顺序反映了CSM上脉冲传播的方向。我们研究了19例房室（AV）折返性心动过速（RT）患者，采用左侧旁路（AP）和21例典型的逆时针心房扑动（AFL）。AVRT和AFL期间通过CSM的传导分别是从左心房（LA）到右心房（RA）和从RA到LA方向。在寻找远场、LA电位时，分析了AP和AFL上逆行传导的CS记录。在19例AP患者中，7例（37%）可见LA电位，均为LA → CSM激活序列，而在21例AFL患者中，14例（67%）可见LA电位，均为CSM-LA激活序列（P<0.0001）。两个研究组的LA电位患病率相似（P=0.1119），总体患病率为53%。在一般人群中，在连续LA和CSM激活期间，经常在CS中记录远场LA电位。CS记录中LA电位的时间反映了CSM的传导方向。
The direction of impulse propagation across the coronary sinus (CS) musculature (CSM) is an important piece of the mechanistic puzzle underlying atrial tachyarrhythmias. We hypothesized that in the general population, the sequence of left atrial (LA) to CSM electrograms recorded in the CS reflects the direction of impulse propagation over the CSM. We studied 19 patients with atrioventricular (AV) reentrant tachycardia (RT) utilizing a left-sided accessory pathway (AP) and 21 patients with typical counterclockwise atrial flutter (AFL). Conduction through the CSM during AVRT and AFL is from the left atrial (LA) to the right atrial (RA) and from the RA to LA direction, respectively. CS recordings of retrograde conduction over the AP and of AFL were analyzed in search of far-field, LA potentials. Among 19 patients with AP, LA potentials were visible in 7 (37%), all in an LA → CSM activation sequence, while among the 21 patients with AFL, LA potentials were visible in 14 (67%), all in a CSM-LA activation sequence (P<0.0001). The prevalence of LA potentials was similar between both study groups (P=0.1119), and the overall prevalence was 53%. Far-field LA potentials are often recorded in the CS during sequential LA and CSM activation in the general population. The timing of LA potentials in CS recordings reflected the direction of conduction across the CSM.