Tai C T, Hsieh M H, Tsai C F, Lin Y K, Yu W C, Lee S H, Ding Y A, Chang M S, Chen S A
Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.
Pacing Clin Electrophysiol. 2000 Oct;23(10 Pt 1):1493-501. doi: 10.1046/j.1460-9592.2000.01493.x.
It was reported that paroxysmal atrial fibrillation (PAF) can be initiated by ectopic atrial beats originating from the pulmonary vein (PV) or left atrial tract (LAT) within the ligament of Marshall (LOM). The aim of this study was to differentiate the LAT from the PV potentials, and to investigate the results of radiofrequency ablation guided by these potentials. Ten patients (age 60 +/- 12 years) with PAF who had a recording of double potentials (DPs) in or around the left PV were included. Group I had five patients with the second deflection of DPs (D2) due to activation of the LAT, and Group II had five patients with D2 due to activation of the PV musculature. There were no significant difference in the isoelectric interval between DPs, the activation time, and amplitude of D2 between Groups I and II. During distal coronary sinus (CS) pacing, the CS ostium (CSO) to D2 interval was shorter compared with that during sinus rhythm in Group I (39 +/- 19 vs 71 +/- 25 ms, P = 0.04), but was longer in Group II (96 +/- 16 vs 44 +/- 19 ms, P = 0.04). During ectopic activation, three patients in Group I, but no Group II patients, had transformation of recorded DPs into triple potentials. Radiofrequency ablation guided by the earliest activation of the LAT potential was performed with transient suppression of PAF, but ablation guided by the earliest activation of the PV potentials had a high success rate in eliminating PAF. In conclusion, differentiating the LAT from the PV potentials for initiation of PAF is feasible by an electrophysiological approach, and may be important for radiofrequency ablation of PAF.
据报道，阵发性心房颤动（PAF）可由起源于肺静脉（PV）或Marshall韧带（LOM）内左心房径路（LAT）的异位心房搏动引发。本研究的目的是区分LAT电位与PV电位，并研究以这些电位为导向的射频消融结果。纳入了10例PAF患者（年龄60±12岁），这些患者在左PV内或其周围记录到双电位（DPs）。第一组有5例患者，其DPs的第二个偏转（D2）是由于LAT激活所致；第二组有5例患者，其D2是由于PV肌组织激活所致。第一组和第二组在DPs之间的等电位间期、激活时间以及D2的幅度方面无显著差异。在远端冠状窦（CS）起搏期间，第一组中CS口（CSO）至D2的间期与窦性心律时相比缩短（39±19 vs 71±25 ms，P = 0.04），而第二组中该间期延长（96±16 vs 44±19 ms，P = 0.04）。在异位激活期间，第一组有3例患者，但第二组无患者，记录到的DPs转变为三电位。以LAT电位最早激活为导向进行射频消融可使PAF短暂抑制，但以PV电位最早激活为导向进行消融在消除PAF方面成功率较高。总之，通过电生理方法区分引发PAF的LAT电位与PV电位是可行的，这对于PAF的射频消融可能很重要。
