Breithardt G, Seipel L
Eur J Cardiol. 1980 Feb;11(2):105-13.
To provide further evidence for the participation of the sinus node in so-called sinus node reentry in man, right atrial stimulation and endocardial mapping were performed in a case with sustained tachycardias which met the commonly accepted criteria for sinus node reentry. In addition to right atrial mapping, the activation of the high left atrium was depicted from the right pulmonary artery. The results clearly showed that in this patient the high right atrium was indeed the site of origin of the atrial echo beats which could be elicited by programmed premature atrial stimulation. The high left atrial electrogram (from the right pulmonary artery) was activated 35 msec after the high right atrium thus excluding the possibility of reentry in Bachmann's bundle. Atrial mapping during echo beats revealed a right atrial activation pattern which was similar to that observed during spontaneous sinus rhythm. Sinus node reentrant beats could also be evoked by programmed premature stimulation of the low lateral right atrium. In conclusion, activation of the high right atrium prior to the high left atrium is an important additional criterion for defining sinus node reentry in man. Thus, the recording of the left atrial signals from the right pulmonary artery helps to exclude reentry in the high left atrium, e.g. Bachmann's bundle.
为了进一步证明窦房结参与人类所谓的窦房结折返，对一例符合公认窦房结折返标准的持续性心动过速患者进行了右心房刺激和心内膜标测。除了右心房标测外，还从右肺动脉描绘了左心房高位的激动情况。结果清楚地表明，在该患者中，右心房高位确实是心房回波搏动的起源部位，这些回波搏动可由程控的房性早搏刺激诱发。左心房高位心电图（来自右肺动脉）在右心房高位激动后35毫秒被激动，从而排除了在房间束发生折返的可能性。在回波搏动期间进行心房标测显示，右心房激动模式与窦性心律时观察到的相似。窦性心律折返搏动也可由低位右心房外侧的程控早搏刺激诱发。总之，右心房高位在左心房高位之前激动是定义人类窦房结折返的一个重要附加标准。因此，从右肺动脉记录左心房信号有助于排除左心房高位（如房间束）发生折返的情况。
