Scheinman Melvin M
Department of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA.
Heart Rhythm. 2009 Jul;6(7):1050-8. doi: 10.1016/j.hrthm.2009.03.011. Epub 2009 Mar 11.
Although a plethora of earlier studies focused on the histology and action potential characteristics of Purkinje fibers, only recently has the His-Purkinje system been found to play a major role in the genesis of cardiac arrhythmias. The anatomic complexity of the left ventricular conduction system appears to favor reentrant arrhythmias in both diseased and healthy hearts. Macroreentrant circuits between the right and left bundles as well as between the left ventricular fascicles are amenable to cure by ablative techniques. Similarly, fascicular tachycardias occurring in individuals without structural cardiac disease appear to involve macroreentrant circuits between fascicles and associated strands (false tendons?). Exciting newer discoveries strongly implicate the Purkinje system as the cause of ventricular arrhythmias in patients with short-coupled premature ventricular complexes and in those with catecholaminergic polymorphous ventricular tachycardia. The role of the His-Purkinje system in the genesis and maintenance of ventricular fibrillation is yet another frontier for fertile investigation. A rich variety of cardiac arrhythmias appears to involve the ventricular specialized conduction system and may be amenable to ablative therapy.
尽管大量早期研究聚焦于浦肯野纤维的组织学和动作电位特征，但直到最近希氏-浦肯野系统才被发现在心律失常的发生中起主要作用。左心室传导系统的解剖复杂性似乎在患病和健康心脏中均有利于折返性心律失常的发生。右束支和左束支之间以及左心室束支之间的大折返环路可通过消融技术治愈。同样，在无结构性心脏病的个体中发生的束支性心动过速似乎涉及束支与相关条索（假腱索？）之间的大折返环路。令人兴奋的新发现有力地表明，浦肯野系统是短联律室性早搏患者以及儿茶酚胺能多形性室性心动过速患者室性心律失常的病因。希氏-浦肯野系统在心室颤动的发生和维持中的作用是另一个有待深入研究的前沿领域。多种心律失常似乎都涉及心室特殊传导系统，并且可能适合消融治疗。
