Atypical Right Atrial Flutter Patterns
Atypical Right Atrial Flutter Patterns
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非典型右心房扑动模式
DOI：
10.1161/01.cir.103.25.3092
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
M. Scheinman
中科院分区：
文献类型：
--
作者：
Yanfei Yang;Jie Cheng;Andy Bochoeyer;M. Hamdan;R. Kowal;R. Page;R. Lee;P. Steiner;L. Saxon;M. Lesh;G. Modin;M. Scheinman
背景--我们研究的目的是明确不典型右房扑动的发生率和机制。方法和结果--在372例房扑患者中，28例(8%)有36次持续的不典型右房扑。在36例下环折返性心动过速(LLR)患者中，13例(54%)在三尖瓣环下端出现早期突破，11例(46%)在高位三尖瓣环处出现早期突破，9例(38%)表现为多环破裂。双向峡部阻滞可消除LLR。在28例患者中，4例(14%)观察到咽鼓脊至鼻中隔的后方穿透。上环折返在36例中有8例(22%)观察到，定义为顺时针方向，早期环状断裂和峡部波前碰撞。2例患者在右心房后外侧低电压区(“疤痕”)周围有不典型的右AFL。结论--不典型的右侧AFL最常与峡部依赖的机制有关(即LLR或上臂下峡部断裂)。非峡部依赖回路包括上环折返或疤痕相关回路。
Background—The purpose of our study was to define the incidence and mechanisms of atypical right atrial flutter. Methods and Results—A total of 28 (8%) of 372 consecutive patients with atrial flutter (AFL) had 36 episodes of sustained atypical right AFL. Among 24 (67%) of 36 episodes of lower loop reentry (LLR), 13 (54%) of 24 episodes had early breakthrough at the lower lateral tricuspid annulus, whereas 11 (46%) of 24 episodes had early breakthrough at the high lateral tricuspid annulus, and 9 (38%) of 24 episodes showed multiple annular breaks. Bidirectional isthmus block resulted in elimination of LLR. A pattern of posterior breakthrough from the eustachian ridge to the septum was observed in 4 (14%) of 28 patients. Upper loop reentry was observed in 8 (22%) of 36 episodes and was defined as showing a clockwise orientation with early annular break and wave-front collision over the isthmus. Two patients had atypical right AFL around low voltage areas (“scars”) in the posterolateral right atrium. Conclusions—Atypical right AFL is most commonly associated with an isthmus-dependent mechanism (ie, LLR or subeustachian isthmus breaks). Non–isthmus-dependent circuits include upper loop reentry or scar-related circuits.