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依赖于房间隔顶部的大折返性左房扑动被可能经房间隔肺静脉束的心外膜传导所掩盖

Roof-dependent Macro-reentrant Left Atrial Flutter Masked by Probable Epicardial Conduction via the Septopulmonary Bundle.

作者信息

Nakatsuka Masataka, Takemoto Masao, Sakai Togo, Tsuchihashi Takuya

机构信息

The Cardiovascular Center, Social Medical Corporation Steel Memorial Yawata Hospital, Kitakyushu, Japan.

出版信息

JMA J. 2025 Jul 15;8(3):1005-1010. doi: 10.31662/jmaj.2025-0112. Epub 2025 Jun 20.

DOI:10.31662/jmaj.2025-0112
PMID:40786496
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12328907/
Abstract

We encountered a 77-year-old woman who had a roof-dependent macro-reentrant left atrial (LA) flutter (LAFL), masked by probable epicardial conduction via the septopulmonary bundle (SPB). The SPB, an epicardial connection in the LA, may contribute to the maintenance and complexity of LAFL. Thus, when evaluating LAFL, physicians should consider the potential involvement of the SPB. Detailed observation using a three-dimensional mapping and comprehensive electrophysiological pacing maneuvers is crucial for identifying the re-entry circuit of LAFL.

摘要

我们遇到一名77岁女性，她患有依赖房顶的大折返性左房（LA）扑动（LAFL），可能通过房间隔肺静脉束（SPB）的心外膜传导掩盖了该情况。SPB是左房的心外膜连接，可能有助于LAFL的维持和复杂性。因此，在评估LAFL时，医生应考虑SPB可能受累。使用三维标测和全面的电生理起搏操作进行详细观察对于识别LAFL的折返环路至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/5ebb9ee76319/2433-3298-8-3-1005-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/bff5b2fe232a/2433-3298-8-3-1005-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/28cbb864e79c/2433-3298-8-3-1005-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/295fb6bf2541/2433-3298-8-3-1005-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/5ebb9ee76319/2433-3298-8-3-1005-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/bff5b2fe232a/2433-3298-8-3-1005-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/28cbb864e79c/2433-3298-8-3-1005-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/295fb6bf2541/2433-3298-8-3-1005-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a453/12328907/5ebb9ee76319/2433-3298-8-3-1005-g004.jpg

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本文引用的文献

1
Epicardial connections inside pulmonary vein antrum isolation lines contribute to initiating and maintaining atrial tachycardia.肺静脉前庭隔离线内的心外膜连接有助于引发和维持房性心动过速。
HeartRhythm Case Rep. 2024 Dec 4;11(3):240-243. doi: 10.1016/j.hrcr.2024.11.021. eCollection 2025 Mar.
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Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021.全球 1990 年至 2021 年房颤/房扑的负担及其归因风险因素。
Europace. 2024 Jul 2;26(7). doi: 10.1093/europace/euae195.
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A novel approach to terminate roof-dependent atrial flutter with epicardial conduction through septopulmonary bundle.
经房间隔肺动脉束行心外膜传导终止依赖房顶的房性心动过速的新方法。
BMC Cardiovasc Disord. 2024 Jul 5;24(1):340. doi: 10.1186/s12872-024-03941-9.
4
Association between sick sinus syndrome and atrial fibrillation: A systematic review and meta-analysis.病态窦房结综合征与心房颤动的相关性：系统评价和荟萃分析。
Int J Cardiol. 2023 Jun 15;381:20-36. doi: 10.1016/j.ijcard.2023.03.066. Epub 2023 Apr 5.
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A case of successful radiofrequency ablation of an epicardial conduction breakthrough site probably via the septopulmonary bundle.一例可能经房间隔肺静脉束成功进行心外膜传导突破点射频消融的病例。
HeartRhythm Case Rep. 2021 Sep 14;7(12):825-828. doi: 10.1016/j.hrcr.2021.09.002. eCollection 2021 Dec.
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Indirect and Direct Evidence for 3-D Activation During Left Atrial Flutter: Anatomy of Epicardial Bridging.左心房扑动期间三维激动的间接和直接证据：心外膜桥接的解剖结构
JACC Clin Electrophysiol. 2020 Dec;6(14):1812-1823. doi: 10.1016/j.jacep.2020.09.022.
7
Epicardial course of the septopulmonary bundle: Anatomical considerations and clinical implications for roof line completion.心外膜间隔肺动脉束走行：完成房顶线时的解剖学考虑及临床意义。
Heart Rhythm. 2021 Mar;18(3):349-357. doi: 10.1016/j.hrthm.2020.11.008. Epub 2020 Nov 11.
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Left atrial anatomy revisited.左心房解剖结构再探讨。
Circ Arrhythm Electrophysiol. 2012 Feb;5(1):220-8. doi: 10.1161/CIRCEP.111.962720.