Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter
Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter
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DOI：
10.1016/j.jacc.2004.01.051
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发表时间：
2004-06-16
影响因子：
24
通讯作者：
Saku, K
中科院分区：
文献类型：
--
作者：
Kumagai, K;Ogawa, M;Saku, K
目的：本研究的目的是评估肺静脉（PV）和左心房（LA）交界处的电生理特性。背景：人们已经认识到房颤（AF）可能起源于pv。然而，PV的电生理特性尚未得到很好的表征。方法对48例阵发性房颤患者的81个PV放置篮状导管，同时记录32个双极电图。在PV远端和PV- la连接处进行程序性刺激。分析了自发性AF发作和单次外刺激诱发AF时pv的激活图。结果远端PV的有效不应期（ERP）明显短于PV- la结（177 +/- 43 vs. 222 +/- 30 ms, p < 0.0001）。远端PV到PV- la结的传导延迟明显长于远端PV （73 +/- 40 vs. 32 +/- 17 ms, p < 0.0001）。在AF开始时，来自PV的短暂耦合外刺激或快速重复的焦点活动形成PV- la往复重入回路，涉及PV- la交界处的出口和入口突破点。此外，PV内存在不稳定的可重入电路。被观察到。结论：PV内和PV- la连接处ERP异质性和各向异性传导特性的存在可能是促进再入形成的关键，因此可能在房颤维持中发挥重要作用。(C) 2004年由美国心脏病学会基金会发布。
OBJECTIVES The purpose of the present study was to evaluate the electrophysiologic properties within the pulmonary vein (PV) and at the PV-Ieft atrial (LA) junction.BACKGROUND It has been recognized that atrial fibrillation (AF) can originate from PVs. However, the electrophysiologic properties of the PV have not been well characterized.METHODS Thirty-two bipolar electrograms were recorded simultaneously from a basket catheter placed in 81 PVs of 48 patients with paroxysmal AF. The programmed stimulation was performed in the distal PV and PV-LA junction. Activation maps of PVs were analyzed from episodes of spontaneous onset of AF and initiation of induced AF by a single extrastimulus.RESULTS The effective refractory period (ERP) of the distal PV was significantly shorter than that of the PV-LA junction (177 +/- 43 vs. 222 +/- 30 ms, p < 0.0001). The conduction delay from the distal PV to the PV-LA junction was significantly longer than that from the PV-LA junction to distal PV (73 +/- 40 vs. 32 +/- 17 ms, p < 0.0001). During initiation of AF, a short coupled extrastimulus or rapid, repetitive focal activities originating from the PV formed a PV-LA reciprocating re-entrant circuit involving exit and entrance breakthrough points at the PV-LA junction. Also, an unstable re-entrant circuit within the PV. was observed.CONCLUSIONS The presence of ERP heterogeneity and anisotropic conduction properties within the PV and at the PV-LA junction may be crucial to promote re-entry formation and thus might play an important role as a substrate for the maintenance of AF. (C) 2004 by the American College of Cardiology Foundation.