Takami Mitsuru, Fujiwara Ryudo, Suzuki Atsushi, Kiuchi Kunihiko, Imamura Kimitake, Tani Kenichi, Iwai Hidehiro, Nakanishi Yusuke, Shoda Mitsuhiko, Murakami Atsushi, Yonehara Shogo, Yamamoto Mari, Asada Hiroyuki, Kunigita Takahiro, Takahashi Ryosuke, Otake Hiromasa, Shite Junya, Fukuzawa Koji
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Cardiovascular Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
Heart Rhythm O2. 2025 Feb 11;6(5):612-621. doi: 10.1016/j.hroo.2025.02.003. eCollection 2025 May.
The electrical conduction properties of the left atrium (LA) in patients with perimitral atrial tachycardia (PMAT) after pulmonary vein isolation (PVI) are not completely understood.
The purpose of this study was to investigate the characteristics of the segmental conduction velocity (CV) in the LA using multisite pacing in patients with PMAT.
After PVI in 179 patients, LA anterograde and retrograde propagation maps were created via pacing at different sites. Segmental CVs were measured in 7 distinct segments of the LA in both maps. Burst pacing was performed to induce atrial tachyarrhythmias.
Twelve PMATs (7 clockwise rotation, 5 counterclockwise rotation) were induced in 11 patients (PMAT group), whereas no atrial tachyarrhythmias were induced in 56 (no induction group). Comparing the segmental CVs between the PMAT and no induction groups, we observed significant reductions in the PMAT group CVs, not only in the anterior and septal regions but also in the roof and bottom regions. Direction-dependent conduction delays were also observed in regions without or with small low-voltage areas, especially in the LA septum, lateral, and bottom. In the PMAT group, the very slow conduction area during PMAT consistently matched the region of the most reduced CV during either anterograde or retrograde propagation. Additionally, the direction of greater conduction delays in the anterior LA identified during pacing studies matched the direction of the PMAT rotation in 9 of 11 patients.
Patients with PMAT showed distinct segmental CVs in the LA, which may influence the tachycardia circuit formation and rotational direction.
肺静脉隔离（PVI）后，二尖瓣环周围房性心动过速（PMAT）患者左心房（LA）的电传导特性尚未完全明确。
本研究旨在通过多部位起搏研究PMAT患者LA节段传导速度（CV）的特征。
对179例患者进行PVI后，通过在不同部位起搏创建LA顺行和逆行传导图。在两张图中测量LA的7个不同节段的节段CV。进行短阵快速起搏以诱发房性快速心律失常。
11例患者（PMAT组）诱发了12次PMAT（7次顺时针旋转，5次逆时针旋转），而56例患者（无诱发组）未诱发房性快速心律失常。比较PMAT组和无诱发组的节段CV，我们观察到PMAT组的CV显著降低，不仅在前部和间隔区域，而且在顶部和底部区域。在无或有小低电压区域的区域也观察到方向依赖性传导延迟，特别是在LA间隔、外侧和底部。在PMAT组中，PMAT期间的极慢传导区域始终与顺行或逆行传导期间CV降低最多的区域匹配。此外，起搏研究中确定的LA前部更大传导延迟的方向与11例患者中9例的PMAT旋转方向匹配。
PMAT患者的LA表现出明显的节段CV，这可能影响心动过速环路的形成和旋转方向。
