Midwest Heart Specialists, Elmhurst, Illinois, USA.
J Cardiovasc Electrophysiol. 2010 Feb;21(2):144-9. doi: 10.1111/j.1540-8167.2009.01607.x. Epub 2009 Oct 5.
The electrophysiological anatomy of cavotricuspid isthmus-dependent atrial flutter (CVTI-AFL) has not been fully elucidated.
We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub-Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium.
In adults, the mean right atrium dimensions were 4.7 cm x 4.5 cm x 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub-Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts.
The posterior boundary of the reentrant circuit of CVTI-AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub-Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI-AFL may provide guidance and improve success during difficult ablations.
尚未充分阐明依赖于心房峡部的三尖瓣峡部依赖性房扑（CVTI-AFL）的电生理学解剖结构。
我们研究了 602 例从 0 岁至 103 岁个体的尸检人心。我们测量了右心房的形态特征，包括心耳终嵴（CT）、梳状肌、Sub-Eustachian 囊、希氏束瓣（TV）和冠状窦口。
在成人中，右心房的平均尺寸为 4.7cm×4.5cm×4.4cm。54%的心脏中梳状肌向 CT 的内侧延伸。在 19%的心脏中，这些梳状肌终止于另一个嵴，称为第二 CT。70%的心脏中梳状肌延伸到 CVTI。Sub-Eustachian 囊存在于 16%的心脏中，始终位于间隔 CVTI 上，并且当 TV 突出时更可能存在。TV 存在于所有心脏的 62%中，其中 9%的 TV 覆盖了 CS 口的下象限。
CVTI-AFL 的折返环的后界包括 Eustachian 嵴和 CT，但在某些患者中可能还包括第二 CT。间隔 CVTI 上的 Sub-Eustachian 囊与突出的 TV 密切相关。CVTI 的外侧可具有明显的梳状肌。对 CVTI-AFL 折返环的电生理学解剖结构的全面描述可能为困难消融提供指导并提高成功率。
