Complex AV nodal dynamics during ventricular-triggered atrial pacing in humans.
Complex AV nodal dynamics during ventricular-triggered atrial pacing in humans.
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人类心室触发心房起搏过程中复杂的房室结动态。
DOI：
10.1152/ajpheart.2001.281.2.h865
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Lerman,BB
中科院分区：
文献类型：
--
作者：
Christini,DJ;Stein,KM;Markowitz,SM;Mittal,S;Slotwiner,DJ;Iwai,S;Lerman,BB
体外实验表明，房室结（AVN）传导动力学的复杂性随着心率的增加而增加。尽管临床上已观察到复杂的 AVN 动态（例如交替），但快速起搏期间的人类 AVN 动态尚未得到系统研究。我们研究了 37 名 AVN 功能正常的患者（18 名具有双 AVN 通路生理学的患者和 19 名不具有双 AVN 通路生理学的患者）在心室触发心房起搏过程中的动态变化。 18 名患者发生了交替传球，其总是由单通路传导引起。 16 名患者（其中 3 名也有交替）出现准正弦 AVN 传导振荡（平均频率 0.02 Hz）；以前没有报道过这种振荡。有或没有双 AVN 通路的患者的动力学没有显着差异。为了阐明控制动态机制，在自主神经阻滞后对 12 名患者进行了第二次心房起搏试验。封锁促进了交替但抑制了振荡。这项研究表明，体内 AVN 快速激发可导致自主介导的 AVN 传导振荡或单通路交替，这是固有非线性动态 AVN 组织特性的函数。
In vitro experiments have shown that the complexity of atrioventricular nodal (AVN) conduction dynamics increases with heart rate. Although complex AVN dynamics (e.g., alternans) have been observed clinically, human AVN dynamics during rapid pacing have not been systematically investigated. We studied such dynamics during ventricular-triggered atrial pacing in 37 patients with normal AVN function (18 patients with dual AVN pathway physiology and 19 patients without). Alternans, which always resulted from single pathway conduction, occurred in 18 patients. In 16 patients (3 of whom also had alternans), quasisinusoidal AVN conduction oscillations occurred (mean frequency 0.02 Hz); such oscillations have not been previously reported. There were no significant differences in the dynamics for patients with or without dual AVN pathways. To illuminate the governing dynamic mechanism, a second atrial pacing trial was performed on 12 patients after autonomic blockade. Blockade facilitated alternans but inhibited oscillations. This study suggests that rapid AVN excitation in vivo can lead to autonomically mediated AVN conduction oscillations or single pathway alternans that are a function of inherent nonlinear dynamic AVN tissue properties.