The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation
The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation
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DOI：
10.1093/eurheartj/ehm606
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发表时间：
2008-02-01
影响因子：
39.3
通讯作者：
Sanchez-Quintana, Damian
中科院分区：
文献类型：
--
作者：
Cabrera, Jose Angel;Ho, Siew Yen;Sanchez-Quintana, Damian
目的观察左肺静脉口与左心耳之间的左外侧脊(LLR)，以进一步了解其与房颤消融相关的结构组成。方法对40例心脏标本进行解剖和组织学切片。左房下缘是房壁的褶皱，其平均宽度上窄于下窄(P<；0.001)。前上节段心肌厚度较后下节段厚(2.8±-1.1vs.1.7+/-0.8 mm，P<0.001)。从心外膜下到心内膜下，LLR由Bachmann束向左延伸的肌纤维、隔肺束和隔房束的下支组成。马歇尔静脉或韧带位于LLR的心外膜侧。在70%的标本上，马歇尔结构和自主神经系统与心内膜表面的距离很近(1 mm；3 mm)。结论LLR的宽度和厚度、与马歇尔结构和自主神经的距离以及肌纤维排列可能在房颤的纤颤过程和扩散过程中起重要作用。
Aims We examined the left lateral ridge (LLR) between the orifices of the left pulmonary veins and the left atrial appendage for a better understanding of its structural composition relevant to ablations for atrial fibrillation (AF).Methods and results The LLR and its surrounding areas were studied in 40 heart specimens by dissection and histological sections. The LLR is a fold of the atrial wall with a mean width that was narrower superiorly than inferiorly (P < 0.001). Its myocardial thickness at the antero-superior level was thicker than at the postero-inferior level (2.8 +/- 1.1 vs. 1.7 +/- 0.8 mm, P < 0.001). Transmurally from subepicardium to subendocardium, the LLR comprises myofibres from the leftward extension of Bachmann's bundle together with the inferior branches of the septopulmonary bundle and the septoatrial bundle. The vein or ligament of Marshall is located on the epicardial aspect of the LLR. The Marshall structures and autonomic nervous system are in close proximity (< 3 mm) to the endocardial surface at the superior level of the ridge in 70% of specimens.Conclusion The variability in width and thickness of the LLR, its proximity to Marshall structures and autonomic nerves, and myofibre arrangement may be significant in the fibrillatory process and spread of AF activity.