Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter
Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter
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DOI：
10.1161/01.cir.94.3.398
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发表时间：
1996-08-01
期刊：
影响因子：
37.8
通讯作者：
Lesh, MD
中科院分区：
文献类型：
--
作者：
Kalman, JM;Olgin, JE;Lesh, MD
背景解剖屏障在心房扑动再入回路中的重要性在犬类模型中得到了很好的证明。前面已经表明，终嵴及其作为咽鼓脊的延伸形成了一个后屏障。在这项研究中，我们检验了三尖瓣环形成颤振回路的连续前屏障的假设。方法与结果对13例典型心房扑动患者进行分析。在三尖瓣环周围放置20极halo导管。在三尖瓣环周围的七个连续位置以及包括右心房附件尖端、卵圆窝和冠状动脉远端在内的另外三个位置，使用了一根测绘导管进行激活和夹带测绘。当起搏后间隔减去颤振周期长度和刺激时间减去激活时间小于或等于ms时，这些位点被认为在回路内；当这些间隔大于10 ms时，这些位点被认为在回路外。所有七个环形站点都在电路内；激活在环空周围依次发生，占颤振周期长度的100%。卵圆窝、冠状窦远端和右心房附件位于回路外。结论三尖瓣环周围紧密间隔的部位依次激活，且均在颤振回路内，符合夹带标准。结果表明，三尖瓣环构成了一个连续的前屏障，限制了人类逆时针心房扑动的再入波前
Background The importance of anatomic barriers in the atrial flutter reentry circuit has been well demonstrated in canine models. It has been shown previously that the crista terminalis and its continuation as the eustachian ridge form a posterior barrier. In this study we tested the hypothesis that the tricuspid annulus forms the continuous anterior barrier to the flutter circuit.Methods and Results Thirteen patients with typical atrial flutter were studied. A 20-pole halo catheter was situated around the tricuspid annulus. A mapping catheter was used for activation and entrainment mapping from seven sequential sites around the tricuspid annulus and from three additional sites including the tip of the right atrial appendage, at the fossa ovalis, and in the distal coronary sius. Sites were considered to be within the circuit when the postpacing interval minus the flutter cycle length and the stimulus time minus the activation time were less-than-or-equal-to ms: sites were considered to be outside the circuit when these intervals were greater-than 10 ms. All seven annular sites were within the circuit; activation occurred sequentially around the annulus and accounted for 100% of the flutter cycle length. The fossa ovalis, the distal coronary sinus, and the right atrial appendage were outside the circuit.Conclusions Closely spaced sites around the tricuspid annulus are activated sequentially, and are all within the flutter circuit according the entrainment criteria. The demonstrates that the tricuspid annulus constitutes a continuous anterior barrier constraining the reentrant wave front of human counterclockwise atrial flutter