Kuz'min V S, Rozenshtraukh L V
Usp Fiziol Nauk. 2010 Oct-Dec;41(4):3-26.
Atrial fibrillation (AF) is the most common supraventricular cardiac arrhythmia. In this review several conceptions focused on the mechanisms of the AF initiation are discussed. At present time viewpoint that the ectopical activity in the pulmonary vien myocardial sleeves (PVs) account for AF in prevailing. PVs myocardium has been the subject of many anatomical and physiological investigations. PVs myocardium differs from left atria tissue and has many moprhological properties that make in convenient substrate for AF initiation and maintenance. PVs cardiomyocytes were shown to have great variability of electrophysiological properties (action potential duration, resting potential, upstroke velocity, etc.). Attempt to discuss afterdepolarization, triggered activity and abnormal automaticity as initiators of AF in PVs was made. It was shown that as in experimental condition, as in vivo in PVs can exist er-entry. Possibly, re-entry from PVs could be the one mechanism by which AF is initiated. In review big attention to the innervations of PVs and role of the sympathetic and the parasympathetic nerves in PVs ectopical activity is paid. Combined influence of autonomic nerves may be critical to initiating AF in PVs. Pharmacological intervention as a possible way to suppress or prevent the activity in the PVs that leads to AF is discussed.
心房颤动（AF）是最常见的室上性心律失常。在这篇综述中，讨论了几种聚焦于心房颤动起始机制的概念。目前，认为肺静脉心肌袖套（PVs）中的异位活动是心房颤动主要原因的观点占主导地位。PVs心肌一直是许多解剖学和生理学研究的对象。PVs心肌与左心房组织不同，具有许多形态学特性，使其成为心房颤动起始和维持的便利基质。PVs心肌细胞表现出电生理特性（动作电位持续时间、静息电位、去极化速度等）的巨大变异性。本文尝试讨论后去极化、触发活动和异常自律性作为PVs中心房颤动的起始因素。结果表明，在实验条件下以及在体内，PVs中都可能存在折返。PVs的折返可能是心房颤动起始的一种机制。在综述中，对PVs的神经支配以及交感神经和副交感神经在PVs异位活动中的作用给予了高度关注。自主神经的联合影响可能是引发PVs中心房颤动的关键因素。本文还讨论了药物干预作为抑制或预防导致心房颤动的PVs活动的一种可能方式。
