Suzuki F, Toshida N, Nawata H, Yamamoto N, Hirao K, Miyasaka N, Kawara T, Hiejima K, Harada T
First Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
J Electrocardiol. 1998 Oct;31(4):345-61. doi: 10.1016/s0022-0736(98)90020-6.
Rapid atrial pacing in sinus rhythm may directly induce atrial flutter without provoking intervening atrial fibrillation, or initiate atrial flutter indirectly, by a conversion from an episode of transient atrial fibrillation provoked by rapid atrial pacing. The present study was performed to examine whether or not the direct induction of clockwise or counterclockwise atrial flutter was pacing-site (right or left atrium) dependent.
We analyzed the mode of direct induction of atrial flutter by rapid atrial pacing. In 46 patients with a history of atrial flutter, rapid atrial pacing with 3 to 20 stimuli (cycle length = 500 - 170 ms) was performed in sinus rhythm to induce atrial flutter from 3 atrial sites, including the high right atrium, the low lateral right atrium, and the proximal coronary sinus, while recording multiple intracardiac electrograms of the atria. Direct induction of atrial flutter by rapid atrial pacing was a rare phenomenon and was documented only 22 times in 15 patients: 3, 11, and 8 times during stimulation, respectively, from the high right atrium, low lateral right atrium, and the proximal coronary sinus. Counterclockwise atrial flutter (12 times) was more frequently induced with stimulation from the proximal coronary sinus than from the low lateral right atrium (8 vs 1, P = .0001); clockwise atrial flutter (10 times) was induced exclusively from the low lateral right atrium (P = .0001 for low lateral right atrium vs proximal coronary sinus, P = .011 for low lateral right atrium vs high right atrium).
Direct induction of either counterclockwise or clockwise atrial flutter was definitively pacing-site dependent; low lateral right atrial pacing induced clockwise, while proximal coronary sinus pacing induced counterclockwise atrial flutter. Anatomic correlation between the flutter circuit and the atrial pacing site may play an important role in the inducibility of counterclockwise or clockwise atrial flutter.
窦性心律下快速心房起搏可直接诱发心房扑动而不引发中间的心房颤动，或通过由快速心房起搏诱发的短暂性心房颤动发作的转变间接引发心房扑动。本研究旨在检验顺时针或逆时针心房扑动的直接诱发是否依赖于起搏部位（右心房或左心房）。
我们分析了快速心房起搏直接诱发心房扑动的方式。在46例有房扑病史的患者中，在窦性心律下进行3至20次刺激（周期长度 = 500 - 170毫秒）的快速心房起搏，以从3个心房部位诱发心房扑动，包括高位右心房、低位外侧右心房和冠状窦近端，同时记录心房的多个心内电图。快速心房起搏直接诱发心房扑动是一种罕见现象，仅在15例患者中记录到22次：分别在来自高位右心房、低位外侧右心房和冠状窦近端的刺激过程中记录到3次、11次和8次。与来自低位外侧右心房的刺激相比，来自冠状窦近端的刺激更频繁地诱发逆时针心房扑动（12次对8次对1次，P = 0.0001）；顺时针心房扑动（10次）仅由低位外侧右心房诱发（低位外侧右心房与冠状窦近端相比P = 0.0001，低位外侧右心房与高位右心房相比P = 0.011）。
逆时针或顺时针心房扑动的直接诱发明确依赖于起搏部位；低位外侧右心房起搏诱发顺时针心房扑动，而冠状窦近端起搏诱发逆时针心房扑动。扑动环路与心房起搏部位之间的解剖学关联可能在逆时针或顺时针心房扑动的诱发中起重要作用。
