Arenal A, Almendral J, San Román D, Delcan J L, Josephson M E
Clinical Electrophysiology Laboratory, Hospital General Gregorio Marañón, Madrid, Spain.
Am J Cardiol. 1992 Nov 15;70(15):1292-8. doi: 10.1016/0002-9149(92)90764-p.
Thirty-three patients (24 with typical and 9 with atypical flutter-wave morphology) were studied to evaluate the incidence and implications of resetting and entrainment of atrial flutter with right atrial stimulation. Resetting with single extrastimulus was present in 23 cases (group A) and absent in 10 (group B). Most cases of reset flutter were typical (20 of 23). Fixed fusion indicative of entrainment was observed in all 29 cases with pacing trains. Groups A and B did not differ significantly in flutter cycle length (230 +/- 20 vs 223 +/- 19 ms), atrial functional refractory period (165 +/- 18 vs 167 +/- 22 ms) or longest paced cycle length producing entrainment (213 +/- 19 vs 210 +/- 19 ms). In contrast, the return cycle after the longest paced cycle length producing entrainment was significantly shorter in group A (228 +/- 27 vs 284 +/- 56 ms; p = 0.001). The return cycle in group A was virtually identical to the flutter cycle length, whereas in group B it was greater (p = 0.002 compared with group A). Resetting was more frequent in typical than atypical flutter (20 of 24 vs 3 of 9; p = 0.01). Both typical and atypical flutter can be transiently entrained by right atrial pacing. Lack of resetting and longer return cycle, suggesting a longer conduction time between the reentrant circuit and the stimulation site, were mostly observed in atypical flutter. The data suggest a different location for both types of flutter, and may have implications for ablation techniques. A more cautious approach, with more extensive mapping, appears appropriate for ablation attempts of atypical flutter.
对33例患者（24例典型心房扑动波形态和9例非典型心房扑动波形态）进行研究，以评估右心房刺激对心房扑动的重整和拖带的发生率及意义。23例患者（A组）存在单个期外刺激重整，10例患者（B组）不存在。重整性心房扑动大多为典型类型（23例中有20例）。在所有29例起搏串刺激的病例中均观察到提示拖带的固定融合波。A组和B组在心房扑动周期长度（230±20 vs 223±19毫秒）、心房功能不应期（165±18 vs 167±22毫秒）或产生拖带的最长起搏周期长度（213±19 vs 210±19毫秒）方面无显著差异。相比之下，A组在产生拖带的最长起搏周期长度后的回波周期明显更短（228±27 vs 284±56毫秒；p = 0.001）。A组的回波周期与心房扑动周期长度几乎相同，而B组则更长（与A组相比，p = 0.002）。典型心房扑动的重整比非典型心房扑动更常见（24例中有20例 vs 9例中有3例；p = 0.01）。典型和非典型心房扑动均可被右心房起搏短暂拖带。非典型心房扑动大多表现为无重整且回波周期更长，提示折返环与刺激部位之间的传导时间更长。数据表明两种类型心房扑动的位置不同，可能对消融技术有影响。对于非典型心房扑动的消融尝试，采用更谨慎的方法并进行更广泛的标测似乎更为合适。
