冠状静脉窦腔内电图与局部肌袖电位的关系探讨

Relationship between coronary sinus electrogram and local electrical activation of coronary sinus muscular sleeve

目的:探讨冠状静脉窦(冠状窦,coronarysinus,CS)腔内电图与局部肌袖电位的关系。方法:室上性心动过速行射频消融术的患者42例。窦性心律下,于冠状窦近端发放递减刺激。观察冠状窦A波激动顺序、波形变化、双电位的有无、冠状窦激动时间。结果:窦性心律时67%的患者的冠状窦远端A波为先正向后负向,波形较宽,成分多。递减刺激首先夺获窦口的A波,使之提前,激动方向改变为先负向后正向。但此时冠状窦远端的A波形态不变、不提前。随刺激的逐渐提前,冠状窦中段、远段的A波提前,且波形改变。窦性心律时,冠状窦激动时间为(24.37±9.41)ms。刺激完全夺获冠状窦时,冠状窦激动时间为(34.62±10.40)ms。两者有非常显著的差异。结论:冠状窦A波不是单纯的心房波,而是肌袖电位和左心房电位的融合波。

Objective： To investigate the coronary sinus（CS） electrogram and the relationship of CS electrogram with local electrical activation of the coronary sinus muscle sleeve （CSMS）, and to demonstrate that A wave of CS electrogram was not only an atrial activating wave, but a complex wave of CSMS potential and left atrial （LA） potential. Methods：Forty-two patients with paroxysmal supraventricular tachycardia（PSVT） were involved. Under sinus rhythm, RS2 stimuli were issued at the proximal CS electrodes （CS9.10）, and then decreased by 5 ms steps. A wave morphology, changing of its order and pattern, double potential and activating time of CS were observed. Results：During sinus rhythm, A wave of distal CS （CS1. 2） in 67% patients showed firstly down and nextly up direction, with broad pattern and multiple compositions. RS2 firstly captured A wave in proximal CS, made it advance in time. Gradually with the decrease of RS2, A wave of CS in the middle segment also advanced, and its pattern changed into firstly down then up direction. When RS2 was early enough, A wave of distal CS（CS1.2） changed into first up then down direction. Conclusion： A wave of CS is not a pure atrial wave, but a potential fusion of CSMS and LA. During sinus rhythm, proximal and middle CS is acti- vated mainly by the pulse through Bachmann bundle and CS, LA potential fuses with CSMS potential. The distal CS is activated by the pulse through Bachmann bundle. Under some conditions, two electric potentials could separate.