揭示房室结双通路电生理的奥秘

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Shuangtao Ma MD, James Rail BS, Youhua Zhang MD, PhD
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引用次数: 0

摘要

随着一种新的双通路电生理学指标的发现和验证,即His电图交替,在理解通过房室(AV)结的电传播方面取得了重大进展。慢速房室传导始于房隔边界(上节域),沿垂直于房室轴的方向,跨纤维方向向三尖瓣环侧(下节域)扩散。这样的激活导致较早的、较优的输入进入较优的His束。这是快速通路(FP)传导。以较快的速率,FP波前逐渐退出下节域,允许在末梢嵴端形成的兴奋通过下节域纵向传播(也沿着纤维方向),从而激活下His束。这是慢速通路(SP)传导。上节域FP传导的失败允许SP波前逆行侵入,形成再入性心动过速,但通常不会形成房室结再入性心动过速。所描述的双通路电生理是房室结传导的正常固有特性。本文还讨论了房室传导曲线跳变和房室结型再入性心动过速的潜在电生理基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Uncovering the mystery of the atrioventricular node dual-pathway electrophysiology
With the discovery and validation of a novel index of dual-pathway electrophysiology, known as the His electrogram alternans, major advances have been made in understanding the electrical propagation through the atrioventricular (AV) node. At slow rates, AV conduction starts at the interatrial septal boundary of the node (superior nodal domain) and spreads toward the tricuspid annulus side (inferior nodal domain) in a direction perpendicular to the AV axis and across fiber orientation. Such activation results in an early, superior input into the superior His bundle. This is the fast pathway (FP) conduction. At fast rates, the FP wavefront gradually withdraws from the inferior nodal domain, permitting excitation formed at the crista terminalis end of the node to propagate longitudinally through the inferior nodal domain (also along the fiber orientation) to activate the inferior His bundle. This is the slow pathway (SP) conduction. The failure of FP conduction in the superior nodal domain permits retrograde invasion of the SP wavefront, forming a re-entry, but normally not AV nodal re-entrant tachycardia. The described dual-pathway electrophysiology is a normal inherent property of AV node conduction. The potential electrophysiological basis for a jump in the AV conduction curve and AV nodal re-entrant tachycardia is also discussed.
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来源期刊
Heart Rhythm O2
Heart Rhythm O2 Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
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审稿时长
52 days
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