Harada A, Sasaki K, Fukushima T, Ikeshita M, Asano T, Yamauchi S, Tanaka S, Shoji T
Department of Cardiovascular Surgery, Ebina General Hospital, Kanagawa, Japan.
Ann Thorac Surg. 1996 Jan;61(1):104-11; discussion 111-2. doi: 10.1016/0003-4975(95)00824-1.
A computerized 32-channel mapping system has been developed to investigate the characteristics of the atrial activation sequence. The system is capable of displaying sequential atrial maps and provides a rapid and dynamic means of verifying the activation sequence of atrial fibrillation.
Using this system, we performed intraoperative atrial activation mapping in 10 patients with chronic atrial fibrillation who were undergoing isolated mitral valve operations.
Regular and repetitive activation (cycle length ranged from 131 to 228 milliseconds) originated in the left atrium in all 10 patients. Two patterns of repetitive activation in 2 patients and three patterns in 1 patient appeared alternately during the observation period in the left atrium. In contrast to the repetitive activation in the left atrium, the activation sequence of the right atrium was extremely complex and chaotic. In 7 of the 10 patients, the same pattern of right atrial activation was never repeated during the observation period. In 2 patients, revolution of repetitive activation in the right atrium sporadically appeared, but the pattern of activation immediately deteriorated to a complex and chaotic pattern. In 1 patient, repetitive activation emerged from the low lateral portion of the right atrium. Because our mapping technique was limited by the number of available atrial electrodes, discrete reentrant circuits or ectopic foci could not be demonstrated in the present study. However, the activation sequences during chronic atrial fibrillation suggested that (1) the left atrium would act as an electrical driving chamber for atrial fibrillation in the majority of the patients and (2) atrial activation patterns are different in each case.
Computerized intraoperative mapping should guide surgeons in determining the appropriate surgical procedure and facilitate operation for chronic atrial fibrillation associated with mitral valve disease.
已开发出一种计算机化的32通道标测系统，用于研究心房激动序列的特征。该系统能够显示连续的心房图，并提供一种快速且动态的方法来验证房颤的激动序列。
使用该系统，我们对10例接受单纯二尖瓣手术的慢性房颤患者进行了术中心房激动标测。
所有10例患者的规则且重复的激动（周期长度为131至228毫秒）均起源于左心房。在观察期内，2例患者的两种重复激动模式和1例患者的三种模式在左心房交替出现。与左心房的重复激动相反，右心房的激动序列极其复杂且紊乱。10例患者中有7例在观察期内右心房的激动模式从未重复。2例患者右心房偶尔出现重复激动的旋转，但激动模式立即恶化为复杂且紊乱的模式。1例患者右心房的重复激动从右心房的下外侧部分出现。由于我们的标测技术受可用心房电极数量的限制，本研究中无法证实离散的折返环或异位灶。然而，慢性房颤期间的激动序列表明：（1）在大多数患者中，左心房将作为房颤的电驱动腔室；（2）每种情况下心房激动模式各不相同。
计算机化术中标测应指导外科医生确定合适的手术方式，并便于对与二尖瓣疾病相关的慢性房颤进行手术。
