Okuyama Yuji, Miyauchi Yasushi, Park Angela M, Hamabe Akira, Zhou Shengmei, Hayashi Hideki, Miyauchi Mizuho, Omichi Chikaya, Pak Hui Nam, Brodsky Lauren A, Mandel William J, Fishbein Michael C, Karagueuzian Hrayr S, Chen Peng Sheng
Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Am Coll Cardiol. 2003 Jul 16;42(2):348-60. doi: 10.1016/s0735-1097(03)00586-2.
The study examined the activations in the pulmonary veins (PVs) and the vein of Marshall (VOM) during atrial fibrillation (AF) in dogs with congestive heart failure (CHF).
The patterns of activation within the PVs and the VOM during AF in CHF are unclear.
We induced CHF in nine dogs by rapid ventricular pacing. The patterns of activation during induced AF were studied one week after ceasing ventricular pacing.
The duration of induced AF averaged 80.7 +/- 177.3 s. The termination of low-amplitude fractionated activity in the PVs preceded the termination of AF in 25 of 29 episodes. High-density mapping (1-mm resolution) showed that the PV was activated by a focal wave front independent of left atrial (LA) activation in 22 AF episodes. Frequent intra-PV conduction blocks and multiple wave fronts in the PVs were recorded during 10 AF episodes. Focal activations were observed within the VOM in 4 of 12 episodes of AF. Three atrial tachycardia (AT) episodes originated from a focus within a PV. Histological studies showed extensive fibrosis in the PVs and in the atria. The PVs in five normal dogs did not have focal or fractionated activity during induced AF.
Atrial fibrillation in canine CHF is associated with independent focal activations in the PVs and the VOM, and with complex wave fronts within the PVs. The PVs may also serve as the origin of AT. These findings suggest that electrical and anatomical remodeling of the PVs and the VOM are important in the maintenance of AF and AT in dogs with CHF.
本研究检测了充血性心力衰竭（CHF）犬心房颤动（AF）期间肺静脉（PVs）和马歇尔静脉（VOM）的激活情况。
CHF犬AF期间PVs和VOM内的激活模式尚不清楚。
我们通过快速心室起搏诱导9只犬发生CHF。在停止心室起搏1周后研究诱导AF期间的激活模式。
诱导AF的持续时间平均为80.7±177.3秒。在29次发作中的25次，PVs中低振幅碎裂活动的终止先于AF的终止。高密度标测（1毫米分辨率）显示，在22次AF发作中，PV由独立于左心房（LA）激活的局灶性波前激活。在10次AF发作期间记录到PVs内频繁的PV内传导阻滞和多个波前。在12次AF发作中的4次，在VOM内观察到局灶性激活。3次房性心动过速（AT）发作起源于PV内的一个病灶。组织学研究显示PVs和心房内有广泛纤维化。5只正常犬的PVs在诱导AF期间没有局灶性或碎裂活动。
犬CHF中的AF与PVs和VOM中的独立局灶性激活以及PVs内的复杂波前有关。PVs也可能是AT的起源。这些发现表明，PVs和VOM的电重构和解剖重构在CHF犬AF和AT的维持中起重要作用。
