利用整体心脏96通道标测系统对心房激动模式的标测及初步应用  

Using 96-channel atrial mapping technique to record intraatrial conduction and activation pattern in intact hearts

作　　者：黄思慧[1] 梁玉芝[2] 杨巧梅[1] 卫晓红[1] 任璐[1] 吴林[1] 

机构地区：[1]北京大学第一医院心内科分子心血管学教育部重点实验室,北京100034 [2]河南省商丘市第一人民医院心内科,河南商丘476100

出　　处：《中国心脏起搏与心电生理杂志》2015年第3期236-241,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：北京市自然科学基金资助(713221)

摘　　要：目的采用96通道心房标测技术,探讨窦性心律(简称窦律)及心房颤动(简称房颤)时,心房内激动传导与激动模式的变化,以及传统钠通道阻滞剂普罗帕酮与选择性晚钠电流抑制剂雷诺嗪对心房传导性的影响。方法雌性新西兰兔Langendorff灌流的整体心脏,使用96通道心房外膜标测技术同步记录左右心房在窦律和房颤时激动传导时间(n=6)。房颤诱发采用S1S2心房程序右房刺激。观察不同浓度的雷诺嗪(1,3,10和30μmol/L,n=7)和普罗帕酮(0.1,0.3,1和3μmol/L,n=8)在窦律时对左右心房传导的影响。结果与窦律时相比,96通道心房外膜标测中房颤发生后出现心房激动传导发生紊乱和异位激动点,左右心房的激动传导时间和平均激动时间显著延长。窦律下,低浓度普罗帕酮(≤0.3μmol/L)与雷诺嗪(≤3μmol/L)引起左右心房房内激动传导时间和平均激动时间的延长较小,统计学不显著,较高浓度的普罗帕酮(≥1μmol/L)与雷诺嗪(≥10μmol/L)均可显著延长房内激动传导时间和平均激动时间(与基础状态相比,P<0.05),但均不改变心房内激动传导模式。结论应用新型96通道标测技术可以直观地显示出房颤发生发展过程中心房内的异位激动点的位置,以及心房传导性与激动模式的改变,评价抗房颤药物对心房激动传导性的影响。Objective A 96-channel mapping technique was used to determine electrical conduction and activation pattern in Langendorff-perfused rabbit atria during sinus rhythm and atrial fibrillation （AF） and the effects of traditional sodium channel blocker propafenone and selective late sodium current inhibitor ranolazine. Methods New-Zealand White female rabbits＇ hearts were isolated and perfused with a Langendorff perfusion setup. Eleetrograms of the fight and left atrium during sinus rhythm and AF were recorded with a 96-channel array mapping system （n = 6 ）. Electrograms were recorded before and after the perfusion of ranolazine（ 1, 3, 10 and 30 la,mol/L, n=7） and propafenone （0.1, 0.3, 1 and 3 μmol/ L, n = 8 ）. The electrograms were analyzed and the isochronal maps were drawn based on the analyzed data with a custombuilt software. Results Compared with hearts in sinus rhythm, intraatrial activation conduction in hearts with AF was delayed, activation conduction time and mean activation time were increased, and activation pattern was disorganized with muhi-ectopic activation sites. At low concentrations, propafenone （ ≤0.3μmol/L） and ranolazine （≤3 μmol/L） slightly but insignificantly prolonged intraatrial activation conduction time , and mean activation time . At high concentrations ,propafenone （ ≥ 1μmol/L） and ranolazine （ ≥ 10 μmol/ L） significantly increased the intraatrial activation conduction time, and mean activation time. Both of them caused no change in the activation pattern of the interatrial conduction. Conclusions Ectopic activation sites in the development of AF, the increases of intraatrial conduction and activation pattern can be determined using a novel 96-channel atrial mapping technique. Sodium current inhibitors increase atrial activation conduction without altering atrial activation pattern.

关 键 词：心血管病学 心房心外膜标测 心房激动传导 心房颤动 钠电流抑制剂 

分 类 号：R541.75[医药卫生—心血管疾病] R331.38[医药卫生—内科学]