Cosio F G, Arribas F, Barbero J M, Kallmeyer C, Goicolea A
Cardiology Service of Hospital Central de la Cruz Roja, Madrid, Spain.
Am J Cardiol. 1988 Apr 1;61(10):775-80. doi: 10.1016/0002-9149(88)91065-x.
Recent mapping studies of atrial flutter have shown that fragmented electrograms can be found in most cases from the posterior, posteroseptal and posterolateral walls of the right atrium. The fragmentation pattern most often consists of a double spike. To further assess double-spike electrograms as a possible marker of conduction delay, bipolar electrograms were continuously recorded during atrial overdrive pacing of common flutter from the right atrium (7 patients) and from the proximal coronary sinus (5). Baseline double-spike separation of 50 to 130 ms was unchanged in 1 patient and slightly increased (5 to 25 ms) in 4 by coronary sinus pacing. The electrogram sequence was unchanged and the surface morphology was similar to that of basal flutter. Right atrial pacing decreased double-spike separation by 25 to 85 ms from basal values of 45 to 175 ms (23 to 83%), suggesting fusion in the area of fragmented electrograms. These findings suggest that double-spike electrograms represent activation on both sides of a conduction delay zone. The changes induced in these electrograms by pacing from the anterior right atrium and the coronary sinus are consistent with flutter circuits rotating counterclockwise (frontal plane) in the posterior right atrial wall in common atrial flutter.
近期对心房扑动的标测研究表明，在大多数情况下，碎裂电图可在右心房后壁、后间隔壁和后外侧壁发现。碎裂模式最常见的是双棘波。为了进一步评估双棘波电图作为传导延迟可能标志物的情况，在对7例患者右心房和5例患者冠状窦近端进行心房超速起搏诱发常见扑动期间，持续记录双极电图。1例患者冠状窦起搏时，基线双棘波间距50至130毫秒未变，4例略有增加（5至25毫秒）。电图序列未变，表面形态与基础扑动相似。右心房起搏使双棘波间距从基础值45至175毫秒减少25至85毫秒（23%至83%），提示在碎裂电图区域存在融合。这些发现表明，双棘波电图代表传导延迟区两侧的激动。从右心房前部和冠状窦起搏诱发的这些电图变化与常见心房扑动时右心房后壁逆时针（额面）旋转的扑动环路一致。
