Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Am Coll Cardiol. 2010 Aug 31;56(10):796-804. doi: 10.1016/j.jacc.2010.03.069.
We sought to determine whether atrial tachycardia arising adjacent to the noncoronary aortic sinus (NCAS-AT) has distinctive atrial activation patterns in relation to targeted anatomic imaging.
The knowledge of atrial activation patterns of the NCAS-AT and its anatomic basis is very limited.
Three-dimensional electroanatomic mapping was performed during NCAS-AT in 13 patients and during sequentially pacing from the noncoronary aortic sinus (NCAS) and the para-Hisian atrial area in 15 reference patients. The spatial relationship between the NCAS and the contiguous atria was studied in another 25 reference patients using computed tomography and in 12 human hearts using gross and microscopic anatomic examination.
During NCAS-AT, the para-Hisian area of the right atrium (RA) and the anteroseptal region of the left atrium were activated almost simultaneously. The initial activation area (within first 20 ms of atrial depolarization) was relatively wide (9.3 +/- 2.6 cm(2) on the RA map and 8.1 +/- 2.1 cm(2) on the left atrium map). In reference patients, NCAS pacing reproduced a biatrial activation pattern of NCAS-AT and resulted in a wider initial activation area than the para-Hisian atrial pacing within first 20 ms of RA activation (10.1 +/- 3.0 cm(2) vs. 3.9+/-1.7 cm(2); p < 0.001). Anatomically, the wall of NCAS did not contain myocardial tissue, but was intimately related to the paraseptal regions of the atria such that the shortest distances from the NCAS to the RA and the left atrium were 1.7 +/- 0.6 mm and 2.3 +/- 0.9 mm (p < 0.01), respectively.
NCAS-AT has distinct atrial activation patterns that can be explained in part by its spatial anatomic relationship with the atria.
我们旨在确定毗邻非冠状动脉窦（NCAS）的房性心动过速（NCAS-AT）是否具有与靶向解剖成像相关的独特心房激活模式。
关于 NCAS-AT 的心房激活模式及其解剖学基础的知识非常有限。
在 13 例患者进行 NCAS-AT 期间以及在 15 例参考患者中依次进行非冠状动脉窦（NCAS）和旁希氏区心房起搏时，进行了三维电解剖标测。在另外 25 例参考患者中使用计算机断层扫描和在 12 个人心脏中使用大体和显微镜解剖检查研究了 NCAS 与连续心房之间的空间关系。
在 NCAS-AT 期间，右心房（RA）的旁希氏区和左心房的前间隔区域几乎同时被激活。初始激活区域（在心房去极化的前 20ms 内）相对较宽（RA 图上为 9.3 +/- 2.6cm²，左心房图上为 8.1 +/- 2.1cm²）。在参考患者中，NCAS 起搏再现了 NCAS-AT 的双心房激活模式，并且在 RA 激活的前 20ms 内导致比旁希氏区心房起搏更宽的初始激活区域（10.1 +/- 3.0cm²对 3.9 +/- 1.7cm²；p < 0.001）。解剖学上，NCAS 的壁不含心肌组织，但与心房的间隔区域密切相关，因此 NCAS 到 RA 和左心房的最短距离分别为 1.7 +/- 0.6mm 和 2.3 +/- 0.9mm（p < 0.01）。
NCAS-AT 具有独特的心房激活模式，这部分可以通过其与心房的空间解剖关系来解释。
