Department of Medicine, National Jewish Health, Denver, Colorado.
Department of Pharmacology, Columbia University, New York, New York.
JACC Clin Electrophysiol. 2017 Dec 11;3(12):1343-1355. doi: 10.1016/j.jacep.2017.07.011. Epub 2017 Sep 27.
Fascicular ventricular arrhythmias represent a spectrum of ventricular tachycardias dependent on the specialized conduction system. Although they are more common in structurally abnormal hearts, there is an increasing body of literature describing their role in normal hearts. In this review, the authors present data from both basic and clinical research that explore the current understanding of idiopathic fascicular ventricular arrhythmias. Evaluation of the cellular electrophysiology of the Purkinje cells shows clear evidence of enhanced automaticity and triggered activity as potential mechanisms of arrhythmias. Perhaps more importantly, heterogeneity in conduction system velocity and refractoriness of the left ventricular conduction system in animal models are in line with clinical descriptions of re-entrant fascicular arrhythmias in humans. Further advances in our understanding of the conduction system will help bridge the current gap between basic science and clinical fascicular arrhythmias.
间隔性室性心律失常代表了一种依赖于特殊传导系统的室性心动过速谱。虽然它们在结构异常的心脏中更为常见，但越来越多的文献描述了它们在正常心脏中的作用。在这篇综述中，作者提出了来自基础和临床研究的数据，探讨了特发性间隔性室性心律失常的当前认识。浦肯野细胞的细胞电生理学评估清楚地表明，自动性增强和触发活动是心律失常的潜在机制。也许更重要的是，动物模型中左心室传导系统的传导系统速度和不应期的异质性与人类复发性间隔性心律失常的临床描述相符。我们对传导系统理解的进一步进展将有助于弥合基础科学和临床间隔性心律失常之间的当前差距。
