Jaïs P, Haïssaguerre M, Shah D C, Chouairi S, Gencel L, Hocini M, Clémenty J
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Circulation. 1997 Feb 4;95(3):572-6. doi: 10.1161/01.cir.95.3.572.
Atrial fibrillation is usually thought to be due to multiple circulating reentrant wavelets. From previous studies, a focal mechanism is considered to be very unlikely. In this report, focal atrial fibrillation is defined on an ECG pattern of atrial fibrillation and later demonstrated to be due to a focal source.
Nine patients (five men and four women, age, 38 +/- 7 years) with paroxysmal focal atrial fibrillation are reported here. All were free of structural heart disease and had frequent episodes of atrial fibrillation despite the use of a mean of 4 +/- 2 antiarrhythmic drugs. Atrial fibrillation was associated with runs of irregular atrial tachycardia or monomorphic extrasystoles. The electrophysiological study demonstrated that all the atrial arrhythmias were due to the same focus firing irregularly and exhibiting a consistent and centrifugal pattern of activation. Three foci were found to be located in the right atrium, two near the sinus node and one in the ostium of the coronary sinus. Six others were located in the left atrium at the ostium of the right pulmonary veins (n = 5) and at the ostium of the left superior pulmonary vein (n = 1). All atrial arrhythmias were successfully treated by use of a mean of 4 +/- 4 radiofrequency pulses.
In some patients, the surface ECG pattern of atrial fibrillation is due to a focal rapidly firing source of activity that can be eliminated by discrete radiofrequency energy applications.
心房颤动通常被认为是由多个循环折返小波引起的。根据以往的研究，局灶机制被认为极不可能。在本报告中，局灶性心房颤动是根据心房颤动的心电图模式定义的，随后证明是由局灶性起源引起的。
本文报告了9例阵发性局灶性心房颤动患者（5例男性，4例女性，年龄38±7岁）。所有患者均无结构性心脏病，尽管平均使用了4±2种抗心律失常药物，但仍频繁发生心房颤动。心房颤动与不规则房性心动过速发作或单形性期前收缩有关。电生理研究表明，所有房性心律失常均由同一病灶不规则发放冲动所致，并呈现出一致的离心性激动模式。发现3个病灶位于右心房，2个靠近窦房结，1个位于冠状窦口。另外6个位于左心房，分别在右肺静脉口（n = 5）和左上肺静脉口（n = 1）。所有房性心律失常均通过平均4±4次射频脉冲成功治疗。
在一些患者中，心房颤动的体表心电图模式是由一个局灶性快速发放冲动的活动源引起的，通过离散的射频能量应用可以消除该活动源。
