Anselme F, Frederiks J, Papageorgiou P, Monahan K M, Epstein L M, Spach M S, Josephson M E
Harvard-Thorndike Institute of Electrophysiology, Beth Israel Hospital, Boston, MA 02215, USA.
J Cardiovasc Electrophysiol. 1996 Dec;7(12):1145-53. doi: 10.1111/j.1540-8167.1996.tb00493.x.
AV nodal reentrant tachycardia cycle length has been shown to be longer in the elderly population. Microfibrosis associated with aging producing nonuniform anisotropic conduction or changes in membrane ionic properties could explain this finding.
Forty-five patients (33 women and 12 men) with typical AV nodal reentrant tachycardia were studied to analyze the effects of age on electrophysiologic characteristics of the tachycardia using high-density catheter mapping of the triangle of Koch. We classified patients into group A (age < or = 45 years, mean [+/-SD] 32.7 +/- 8.8, n = 27) and group B (age > 45 years, mean [+/-SD] 61.1 +/- 10.2, n = 18). Retrograde atrial activation was recorded during tachycardia by means of a 2-mm decapolar catheter at the His bundle, a quadripolar catheter at the high right atrium, a multipolar catheter (6 to 10 poles) in the coronary sinus, and a deflectable quadripolar catheter at the posterior triangle of Koch. The AH interval at the AV junction as well as HA intervals at several atrial sites were measured during tachycardia. HA intervals at all atrial recording sites except in the posterior triangle of Koch were significantly longer in group B, as well as the tachycardia cycle length (362 vs 329 msec, P = 0.01). The mean AH interval was prolonged by 24 msec in group B, but this difference did not reach statistical significance. A sequential pattern of retrograde atrial activation during tachycardia was more frequently recorded in group B.
Since the delayed activation to the atrium was heterogeneous, transverse nonuniform anisotropic conduction is a likely explanation of these age-related modifications of AV nodal reentrant tachycardia characteristics.
房室结折返性心动过速的周期长度在老年人群中较长。与衰老相关的微纤维化导致非均匀各向异性传导或膜离子特性改变，可能解释了这一发现。
对45例典型房室结折返性心动过速患者（33例女性和12例男性）进行研究，通过科赫三角的高密度导管标测分析年龄对心动过速电生理特征的影响。我们将患者分为A组（年龄≤45岁，平均[±标准差]32.7±8.8，n = 27）和B组（年龄＞45岁，平均[±标准差]61.1±10.2，n = 18）。在心动过速期间，通过希氏束处的2毫米十极导管、高位右心房处的四极导管、冠状窦内的多极导管（6至10极）以及科赫后三角处的可弯曲四极导管记录逆行心房激动。在心动过速期间测量房室结处的AH间期以及几个心房部位的HA间期。除科赫后三角外，B组所有心房记录部位的HA间期均显著延长，心动过速周期长度也显著延长（362对329毫秒，P = 0.01）。B组的平均AH间期延长了24毫秒，但这一差异未达到统计学意义。B组更频繁记录到心动过速期间逆行心房激动的顺序模式。
由于心房延迟激动是异质性的，横向非均匀各向异性传导可能是房室结折返性心动过速特征的这些与年龄相关改变的原因。
