Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey.
JACC Clin Electrophysiol. 2018 Jan;4(1):1-16. doi: 10.1016/j.jacep.2017.08.019. Epub 2017 Nov 15.
Ventricular tachycardia (VT) caused by a re-entrant circuit is a life-threatening arrhythmia that at present cannot always be treated adequately. A realistic model of re-entry would be helpful to accurately guide catheter ablation for interruption of the circuit. In this review, models of electrical activation wavefront propagation during onset and maintenance of re-entrant VT are discussed. In particular, the relationship between activation mapping and maps of transition in infarct border zone thickness, which results in source-sink mismatch, is considered in detail and supplemented with additional data. Based on source-sink mismatch, the re-entry isthmus can be modeled from its boundary properties. Isthmus boundary segments with large transitions in infarct border zone thickness have large source-sink mismatch, and functional block forms there during VT. These alternate with segments having lesser thickness change and therefore lesser source-sink mismatch, which act as gaps, or entrance and exit points, to the isthmus during VT. Besides post-infarction substrates, the source-sink model is likely applicable to other types of volumetric changes in the myocardial conducting medium, such as when there is presence of fibrosis or dissociation of muscle fibers.
由折返环引起的室性心动过速（VT）是一种危及生命的心律失常，目前并非总能得到充分治疗。折返的现实模型将有助于准确指导导管消融以中断该环。在这篇综述中，讨论了折返性 VT 发作和维持期间电激活波前传播的模型。特别是，详细考虑了激活映射与梗死交界区厚度过渡映射之间的关系，这导致了源-汇失配，并补充了其他数据。基于源-汇失配，可以根据其边界特性对折返峡部进行建模。梗死交界区厚度有较大过渡的峡部边界段具有较大的源-汇失配，在 VT 期间会形成功能性阻滞。它们与厚度变化较小的段交替存在，因此在 VT 期间作为峡部的间隙或入口和出口点，源-汇失配较小。除了梗死后基质外，源-汇模型可能适用于心肌传导介质中其他类型的容积变化，例如存在纤维化或肌肉纤维分离时。
