Cosio F G, Goicolea A, López-Gil M, Arribas F, Barroso J L, Chicote R
Cardiology Service of Hospital Central de la Cruz Roja, Universidad Complutense, Madrid, Spain.
Am J Cardiol. 1990 Sep 15;66(7):715-20. doi: 10.1016/0002-9149(90)91136-t.
Endocardial atrial activation mapping was performed in 7 patients with rare atrial flutter (AF), inscribing predominantly positive deflections on leads II, III and aVF. In 2 cases both a rare and a common AF were mapped on different occasions. Every case displayed circular right atrial activation. In 5 of the 7 cases rare AF direction was clockwise (craniocaudal in the septum and posterior wall and caudocranial on the lateral and anterior walls). In 2 cases rare AF direction was counterclockwise (caudocranial in the septum and posterior wall and craniocaudal in the lateral and anterior walls). Both common AF rotated counterclockwise. A "line" of conduction delay or block was present in both clockwise and counterclockwise circuits between the posterior and lateral walls, in the probable location of the crista terminalis. This line of block extended the central obstacle made by the inferior vena cava toward, but perhaps not all the way to, the superior vena cava, making activation rotate roughly around the tricuspid ring. The ridge between the inferior vena cava and the tricuspid ring was a critical anatomic "closing" point in all clockwise and counterclockwise circuits. Right atrial macroreentry underlies rare AF. Direction of activation tends to be opposite to that in common AF. The cause of the positive deflection is unclear.
对7例罕见心房颤动（AF）患者进行了心内膜心房激动标测，在Ⅱ、Ⅲ和aVF导联上主要记录到正向波。2例患者在不同时间分别标测了罕见型和常见型AF。每例均显示右心房呈环形激动。7例中有5例罕见型AF的激动方向为顺时针（在间隔和后壁为头向尾，在侧壁和前壁为尾向头）。2例罕见型AF的激动方向为逆时针（在间隔和后壁为尾向头，在侧壁和前壁为头向尾）。两种常见型AF均为逆时针旋转。在后壁和侧壁之间的顺时针和逆时针环路中，在终末嵴的可能位置均存在一条传导延迟或阻滞“线”。这条阻滞线将下腔静脉形成的中央障碍物延伸至但可能未完全到达上腔静脉，使激动大致围绕三尖瓣环旋转。下腔静脉和三尖瓣环之间的嵴在所有顺时针和逆时针环路中均为关键的解剖学“闭合”点。右心房大折返是罕见型AF的基础。激动方向往往与常见型AF相反。正向波的原因尚不清楚。
