Heart Failure Research Center, Academic Medical Center, Amsterdam, The Netherlands.
Heart Rhythm. 2009 Dec;6(12):1818-24. doi: 10.1016/j.hrthm.2009.07.011. Epub 2009 Jul 15.
The myocardial sleeves of the systemic venous tributaries and the pulmonary veins are known to be common anatomic substrates for atrial fibrillation. Rapidly evolving evidence has shown that a substantial part of the paroxysmal variant of this abnormal rhythm has a familial heritage, and the number of genes found to be involved is increasing. One of the mechanisms underlying the condition is ectopic pacemaking activity. Knowledge of the normal embryological development of the atrial myocardium, in particular the myocardial sleeves clothing the systemic venous tributaries and the pulmonary veins at their junctions with the atrial chambers, may contribute to the understanding of the origins of such ectopic pacing. In this respect, it is now well established that the myocardial sleeves of the systemic venous tributaries have a distinct origin and program of gene expression when compared with the pulmonary venous myocardium. The myocardium clothing the pulmonary veins, however, is particularly susceptible to changes in the levels of gene expression, with the changes then favoring the presence of genes responsible for pacemaking. Only recently has interest developed in the genetic and heritable bases of atrial fibrillation, and much is still to be learned. Better understanding of both the developmental and genetic factors, nonetheless, will surely be helpful in the diagnosis, prevention, and treatment of this troublesome arrhythmia. With this in mind, therefore, we have reviewed the current knowledge concerning the initial development of the pulmonary venous myocardium, emphasizing its crucial differences from the systemic venous myocardium.
已知体静脉属支和肺静脉的心肌袖是心房颤动的常见解剖学基础。快速发展的证据表明，这种异常节律的阵发性变体有很大一部分具有家族遗传，并且发现涉及的基因数量正在增加。该病症的一种机制是异位起搏活动。了解心房心肌的正常胚胎发育，特别是在与心房腔交界处的体静脉属支和肺静脉上的心肌袖，可能有助于理解这种异位起搏的起源。在这方面，现在已经确定，与肺静脉心肌相比，体静脉属支的心肌袖具有独特的起源和基因表达程序。然而，肺静脉的心肌对基因表达水平的变化特别敏感，随后的变化有利于存在负责起搏的基因。直到最近，人们才对心房颤动的遗传和遗传性基础产生兴趣，还有很多需要了解。更好地了解发育和遗传因素肯定有助于这种麻烦的心律失常的诊断、预防和治疗。有鉴于此，因此，我们回顾了有关肺静脉心肌初始发育的现有知识，强调了它与体静脉心肌的关键差异。
