Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Circ Arrhythm Electrophysiol. 2010 Dec;3(6):600-5. doi: 10.1161/CIRCEP.110.951525. Epub 2010 Sep 18.
The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques.
We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection. The sinus node artery (SNA) arose from the circumflex artery in 42% of case; proximal to the LA appendage in 29%, crossing the left atrium (LA) anterior wall; and after the LA appendage in the remaining 13%, crossing the mitral isthmus and passing close to the left pulmonary veins (PVs), the LA roof, and the right superior PV. In 58%, the SNA arose from the right coronary artery. Major arteries (≥ 1 mm in external diameter) were found in the mitral isthmus in 54%, at the LA roof in 54%, and at the LA anterior wall in 29%. Around the left PV ostia, there were areas with major arteries in up to 37% (at the roof and inferior segments) and around the right PV ostia in up to 29% (at the roof segment).
Major atrial coronary arteries, including the SNA, were commonly found in the areas involved in AF ablation and could cause difficulties in obtaining transmural lesions and electric isolation or even lead to ischemic sinus node or atrial dysfunction.
在射频消融过程中，临近血管结构是一个限制因素。然而，在房颤（AF）导管消融技术的发展过程中，人们很少或根本没有关注心房动脉循环。
我们通过彩色树脂注射和仔细解剖检查了 24 个心脏标本中涉及 AF 消融区域的心房动脉循环。窦房结动脉（SNA）起源于 42%的病例中的回旋支动脉；29%起源于左心房（LA）附件近端，穿过左心房前壁；13%起源于 LA 附件后，穿过二尖瓣峡部并靠近左肺静脉（PV）、LA 顶和右上 PV。在 58%的情况下，SNA 起源于右冠状动脉。在二尖瓣峡部（54%）、LA 顶（54%）和 LA 前壁（29%）发现了外径≥1mm的主要动脉。在左 PV 口周围，高达 37%（屋顶和下节段）和右 PV 口周围高达 29%（屋顶节段）存在主要动脉区域。
包括 SNA 在内的主要心房冠状血管常见于 AF 消融区域，可能导致获得透壁病变和电隔离困难，甚至导致缺血性窦房结或心房功能障碍。
