Kumagai K, Yasuda T, Tojo H, Noguchi H, Matsumoto N, Nakashima H, Gondo N, Saku K
Department of Cardiology, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan.
Pacing Clin Electrophysiol. 2000 Nov;23(11 Pt 2):1823-7. doi: 10.1111/j.1540-8159.2000.tb07029.x.
Most episodes of focal atrial fibrillation (AF) can be initiated by premature beats originating from the pulmonary veins (PV). However, the role of rapid focal activation in the maintenance of AF is unclear. Thirty-two patients with focal AF who underwent focal ablation of triggering ectopic beats were studied. Bipolar electrograms from all four PVs were recorded simultaneously. The cycle length (CL) of RFA at sites that triggered AF was measured at AF onset, after 5 minutes of sustained AF, and just before the spontaneous termination of 32 episodes of nonsustained AF. Fifteen episodes of sustained AF (> 10 minutes) and 17 episodes of nonsustained AF (5-120 seconds, mean 56 +/- 59 seconds) were analyzed. In sustained AF, the mean CL of RFA in the PV from which it originated was not significantly different than in the other PVs, and RFA was continuously observed. In nonsustained AF, the mean CL of RFA in a PV from which it originated was significantly shorter than in other PVs and, when RFA disappeared, AF terminated. RFA in 1 PV induced RFA in another PV. In conclusion, widespread conduction of RFA from a PV at its source to the other sites may be necessary for the sustenance of AF. A PV interaction, a RFA triggering another, may be involved in the maintenance of AF. RFA arising from PVs is important not only as a trigger of onset, but also in the maintenance of AF.
大多数局灶性心房颤动（AF）发作可由起源于肺静脉（PV）的早搏引发。然而，快速局灶性激动在房颤维持中的作用尚不清楚。对32例接受局灶性触发异位搏动消融术的局灶性房颤患者进行了研究。同时记录所有四条肺静脉的双极电图。在房颤发作时、持续房颤5分钟后以及32次非持续性房颤自发终止前，测量触发房颤部位的射频消融（RFA）周期长度（CL）。分析了15次持续性房颤（>10分钟）和17次非持续性房颤（5 - 120秒，平均56±59秒）。在持续性房颤中，起源肺静脉的RFA平均CL与其他肺静脉相比无显著差异，且持续观察到RFA。在非持续性房颤中，起源肺静脉的RFA平均CL显著短于其他肺静脉，当RFA消失时，房颤终止。一条肺静脉的RFA可诱发另一条肺静脉的RFA。总之，起源肺静脉的RFA向其他部位的广泛传导可能是房颤维持所必需的。肺静脉间相互作用，即一条RFA触发另一条，可能参与房颤的维持。起源于肺静脉的RFA不仅作为发作的触发因素很重要，在房颤维持中也很重要。
