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Study of underlying mechanism of chronic atrial fibrillation and development of new less invasive surgery

慢性心房颤动的潜在机制研究及新型微创手术的开发

基本信息

批准号：
10470275
负责人：
SUEDA Taijiro
金额：
$ 7.36万
依托单位：
HIROSHIMA UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B).
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 2000
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-10470275/
关键词：
atrial fibrillation maze procedure electrophysiological study earliest activation time fast Fourier transform PVO isolation less invasive surgery Backman束電位

项目摘要

To examine the electrophysiological characteristics of chronic atrial fibrillation associated with valvular disease, electrical activity of atrial fibrillation was mapped on the atrial surface by means of multi-point electrodes and specially made mapping system. Data were mainly acquired from the atrial free wall of both atria and anatomical obstacles, such as the orifice of pulmonary veins, and were analyzed using specially designed software. In this study, "macroreentry" was not detected but other new propagation patterns were found. Using spectral analysis, electrophysiological difference was noted between both atria. These findings suggest that early activation occurred from the left atrium and propagated to the right atrium and thus chaotic activation pattern was formed in the right atrium because of unequal refractory period on the right atrium.We developed a new, more simple surgical procedure, named as "pulmonary vein orifice isolation procedure", based on these electrophysiological findings. To eliminate chronic atrial fibrillation, we performed this procedure associated with mitral valve surgery and successfully set these patients, then, more than 80% of these free from atrial fibrillation postoperatively. Large left atrial dimension and long duration of preoperative atrial fibrillation was the predictive factor for the recurring atrial fibrillation. Small difference of electrophysiological status in both atria also predicted postoperative outcome. From the echocardiographic examination, posloperative cardiac performance was excellent in those cases who regained sinus rhythm and left atrial kick in the transmitral flow was observed in the majority of those patients.

为了检查与瓣膜病相关的慢性心房颤动的电生理特征，通过多点电极和特制的标测系统将心房颤动的电活动标测到心房表面。数据主要从心房的心房游离壁和解剖障碍（例如肺静脉口）获取，并使用专门设计的软件进行分析。在这项研究中，没有检测到“宏观折返”，但发现了其他新的传播模式。使用频谱分析，注意到两个心房之间的电生理差异。这些发现表明，早期激活从左心房开始并传播到右心房，由于右心房的不应期不等，因此在右心房形成混乱的激活模式。基于这些电生理学发现，我们开发了一种新的、更简单的手术方法，称为“肺静脉孔口隔离手术”。为了消除慢性房颤，我们进行了与二尖瓣手术相关的手术，并成功地使这些患者康复，术后80%以上的患者不再出现房颤。左心房尺寸大、术前房颤持续时间长是房颤复发的预测因素。两个心房电生理状态的微小差异也可以预测术后结果。从超声心动图检查来看，那些恢复窦性心律的病例术后心脏功能良好，大多数患者观察到二尖瓣血流中左心房搏动。