心房颤动的研究现状_江洪演示文稿.pptVIP

Prolongation of A-H interval and 2:1 AV conduction block were induced by HFS (1.5V) at the LSPV; 说明是刺激神经成分 Significant slowing of AV conduction was induced by HFS (2.4V) at LIPV during atrial fibrillation (AF). AV block was observed just before initiation of AF. Focal firing-mediated AF was initiated by HFS (1.5V) from RSPV 说明4个GP的位置，强调这些PV被临近的GP支配，GP发出轴突伸向临近的PV和atria，这些PV focal firing可能跟GP有关。肺静脉消融所取得的成功率可能跟Denervation有关 注意图示 经典模型－chronic atrial rapid pacing 我们一般认为chronic atrial rapid pacing引起的AF model都是折返机制，但是这个研究显示了chronic atrial rapid pacing引起的sustained AF可能是Focal机制，甚至是AF的主导因素。 Focal activation in the LSPV of dog 2?during sustained AF (unipolar recording). A-C: isochronal maps of 3?beats at different times (shown above each panel) during the same 8-s recording. The number in the parenthesis indicates the time with the onset of data acquisition as time 0. The earliest activation repeatedly arose from middle of the PV. Numbers in the map indicate the activation time in milliseconds relative to the earliest activation of a particular beat. D: corresponding unipolar electrograms at channels a-g shown on A, with the earliest activation seen at channels d1 and d2. Note the conduction delay and block from the focal site to the distal PV and LA-PV junction. The dashed line in A indicates the PV-LA junction. Numbers (0?and 0.75) on the electrogram indicate 0?and 0.75?s, respectively, since the onset of data acquisition. 心房电重构 Nattel et al. JICE. 2005 Chen PS et al. AJP. 2002 Focal Activity in Chronic Pacing induced AF Focal Activity in Chronic Pacing induced AF Chen PS et al. AJP. 2002 Right Thoracotomy Left Thoracotomy IVC RA RIPV RAA Anterior Right GP Inferior Right GP RSPV SVC LV LPA LSPV LIPV RV LA Superior Left GP Inferior Left GP LAA Pacing 1200/min for 6 hrs LAA Lu Z, Jiang H and Sunny Po. Circ. 2008 心房电重构的神经机制 14 dogs EP Testing: ERP, AF Induction EP Testing: ERP, AF Induction EP Testing: ERP, AF Induction EP Testing: ERP, AF Induction 6 hr LAA pacing (1