Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
Heart Rhythm. 2012 Feb;9(2):258-64. doi: 10.1016/j.hrthm.2011.09.010. Epub 2011 Sep 9.
The pulmonary veins (PVs) and the PV-LA (left atrium) junction are established sources of triggers initiating atrial fibrillation. In addition, they have been implicated in the maintenance of arrhythmia.
To undertake high-density electrophysiological characterization of the right superior PV-LA junction in humans.
Mapping was performed in 18 patients without a history of atrial fibrillation undergoing cardiac surgery. A high-density epicardial plaque was positioned at the anterior right superior pulmonary vein covering 3 regions: LA, PV-LA junction, and the PV. Isochronal maps were created during (1) sinus rhythm (SR); (2) LA pacing (LA-Pace); (3) PV pacing (PV-Pace); (4) LA programmed electrical stimulation (LA-PES); and (5) PV programmed electrical stimulation (PV-PES). Regional differences in conduction slowing/conduction block (CS/CB) and the prevalence of fractionated signals (FS) and double potentials (DPs) were assessed.
A region of isochronal crowding representing CS/CB developed at the PV-LA junction in 84% of the maps. Three distinct activation patterns were seen. Pattern 1: Uniform SR activation without CS/CB. LA-Pace and PES caused 1 to 2 lines of isochronal crowding (CS/CB) at the PV-LA junction. Pattern 2: CS/CB occurred at the PV-LA junction in SR. LA/PV-Pace and LA/PV-PES caused an increase in CS/CB at the PV-LA junction with widely split DPs and FS. Pattern 3: A single incomplete line of CS at the PV-LA junction in SR. With LA/PV pacing and LA/PV-PES, multiple lines (≥3) of CS/CB developed at the PV-LA junction with evidence of circuitous activation and a marked increase in DPs and FS.
High-density epicardial mapping of the right superior pulmonary vein demonstrates marked functional conduction delay and circuitous activation patterns at the PV-LA junction, creating the substrate for reentry.
肺静脉（PVs）和 PV-LA（左心房）交界处是引发心房颤动的触发源。此外，它们与心律失常的维持有关。
对人类右肺静脉上腔交界部进行高密度电生理特征描述。
在 18 例无房颤病史的心脏手术患者中进行了标测。一个高密度的心脏外膜斑块被放置在前右肺静脉上方，覆盖 3 个区域：LA、PV-LA 交界处和 PV。在窦性心律（SR）、LA 起搏（LA-Pace）、PV 起搏（PV-Pace）、LA 程控电刺激（LA-PES）和 PV 程控电刺激（PV-PES）时创建等时图。评估传导减慢/传导阻滞（CS/CB）的区域差异以及分叶信号（FS）和双电位（DPs）的发生率。
在 84%的图谱中，PV-LA 交界处出现了代表 CS/CB 的等时拥挤区域。观察到三种不同的激活模式。模式 1：无 CS/CB 的均匀 SR 激活。LA-Pace 和 PES 在 PV-LA 交界处引起 1 至 2 行等时拥挤（CS/CB）。模式 2：SR 时在 PV-LA 交界处发生 CS/CB。LA/PV-Pace 和 LA/PV-PES 引起 PV-LA 交界处 CS/CB 增加，出现广泛分离的 DP 和 FS。模式 3：SR 时在 PV-LA 交界处只有一条不完全的 CS 线。LA/PV 起搏和 LA/PV-PES 时，PV-LA 交界处出现多条（≥3）CS/CB，存在迂回激活，并出现 DP 和 FS 明显增加。
右肺静脉上腔的高密度心脏外膜标测显示，PV-LA 交界处存在明显的功能性传导延迟和迂回激活模式，为折返提供了基质。
