Deen Vincent R, Morton Joseph B, Vohra Jitendra K, Kalman Jonathan M
Department of Cardiology, The Royal Melbourne Hospital, and the University of Melbourne, Australia.
J Cardiovasc Electrophysiol. 2002 Feb;13(2):101-7. doi: 10.1046/j.1540-8167.2002.00101.x.
Atrial fibrillation (AF) may originate from a single focus, with the vast majority observed within the pulmonary veins. To facilitate mapping, we hypothesized that there would be a characteristic right atrial endocardial activation sequence pattern associated with pacing and spontaneous focal activity from each of the four pulmonary veins.
In 10 patients with focal AF, a standardized set of catheters was positioned in the right atrium. These included a 20-pole catheter along the crista terminalis, a decapolar catheter in the coronary sinus (CS), and a His-bundle electrode. Pacing (700 and 300 msec) was performed with a mapping catheter from each of the four pulmonary veins. Activation sequence maps were created by measurement of activation times to each of the recording bipoles with the proximal CS bipole as the arbitrary reference point. Similar maps were constructed for the activation sequence of the pulmonary vein ectopic that initiated AF. There was a characteristic right atrial activation map created by pacing each pulmonary vein that corresponded closely with the map from the same pulmonary vein during initiation of focal AF. The pulmonary vein of origin could be distinguished on the basis of this characteristic pattern and some stereotypic observations. CS activation occurred proximal to distal for right pulmonary veins and distal to proximal for left pulmonary veins. Significant differences in activation timing between the CS and crista terminalis differentiated upper from lower pulmonary veins.
There is a characteristic right atrial activation map for activity arising from each of the four pulmonary veins that corresponded closely with the map from the same pulmonary vein during initiation of focal AF. These findings may facilitate mapping and ablation of focal AF.
心房颤动（AF）可能起源于单一病灶，绝大多数病灶位于肺静脉内。为便于标测，我们假设与来自四条肺静脉中每一条的起搏及自发局灶性活动相关的右心房内膜激动序列模式具有特征性。
在10例局灶性AF患者中，将一套标准化导管置于右心房。这些导管包括沿界嵴放置的一根20极导管、位于冠状窦（CS）的一根十极导管以及一根希氏束电极。使用标测导管从四条肺静脉中的每一条进行起搏（700和300毫秒）。以近端CS双极电极为任意参考点，通过测量至每个记录双极电极的激动时间来创建激动序列图。为引发AF的肺静脉异位激动的序列构建了类似的图。通过对每条肺静脉进行起搏创建的右心房激动图具有特征性，与局灶性AF起始时来自同一肺静脉的图密切对应。根据这种特征性模式和一些刻板观察结果可区分起源的肺静脉。右肺静脉起搏时CS激动从近端向远端，左肺静脉起搏时CS激动从远端向近端。CS与界嵴之间激动时间的显著差异区分了上、下肺静脉。
来自四条肺静脉中每一条的活动均有特征性的右心房激动图，与局灶性AF起始时来自同一肺静脉的图密切对应。这些发现可能便于局灶性AF的标测与消融。
