Friedman P L, Brugada P, Kuck K H, Roy D, Farre J, Bär F W, Wellens H J
Am J Cardiol. 1982 Oct;50(4):756-61. doi: 10.1016/0002-9149(82)91230-9.
Programmed electrical stimulation of the heart was performed in 2 patients with spontaneous atrial flutter. Patient 1 was a young man with paroxysmal atrial flutter that had proved resistant to drug therapy and who was studied during an episode of sustained flutter. In this patient rapid atrial pacing from the coronary sinus at a critical rate faster than the intrinsic flutter rate provoked local atrial fibrillation in the mid and low right atrium which persisted after termination of pacing. In spite of persistent local fibrillation in these regions, atrial flutter continued in the left atrium and the high right atrium. A second burst of pacing resulted in restoration of sinus rhythm. Patient 2 was an elderly woman with probable sick sinus syndrome who developed spontaneous atrial flutter during the course of an electrophysiologic investigation. During flutter intracavitary recordings from multiple sites in the atria revealed a pattern of 3:2 Wenckebach conduction between the left atrium and the high right atrium, with block of every third atrial depolarization at the latter site. These results indicate that atrial flutter may exist at some sites in the atria which are functionally dissociated from the remainder of the atrial tissue, thus supporting the hypothesis that flutter in some patients may be focal in origin.
对2例自发性心房扑动患者进行了心脏程控电刺激。患者1是一名年轻男性，阵发性心房扑动，药物治疗无效，在持续性扑动发作期间接受研究。在该患者中，以高于固有扑动率的临界频率从冠状窦进行快速心房起搏，诱发了右心房中下部的局部心房颤动，起搏终止后仍持续存在。尽管这些区域持续存在局部颤动，但左心房和右心房上部仍继续存在心房扑动。第二次起搏脉冲导致窦性心律恢复。患者2是一名老年女性，可能患有病态窦房结综合征，在电生理检查过程中出现自发性心房扑动。在扑动期间，心房多个部位的腔内记录显示左心房和右心房上部之间存在3:2文氏传导模式，后者部位每第三次心房去极化发生阻滞。这些结果表明，心房扑动可能存在于心房的某些部位，这些部位与心房组织的其余部分在功能上分离，从而支持了某些患者的扑动可能起源于局灶性的假说。
