蒲肯野纤维与室性心律失常  

Cardiac Purkinje fibers and ventricular arrhythmias

作　　者：李毅刚[1] 李威[1] 

机构地区：[1]上海交通大学医学院附属新华医院心内科,上海200092

出　　处：《临床心血管病杂志》2017年第3期197-199,共3页Journal of Clinical Cardiology

摘　　要：心脏蒲肯野纤维是由蒲肯野细胞形成的纤维状网样结构,与房室束相连结,广泛分布于心内膜,在电冲动向心室肌的快速传播过程中起着重要的作用,使得左右心室快速同步激动。近年来的研究表明蒲肯野纤维好发心律失常,这主要是由于其解剖的复杂性和独特的细胞超微结构、电生理特性以及兴奋-收缩偶联的模式所导致的。蒲肯野纤维不仅可发生自律性和触发性心律失常,还可以发生折返性心律失常。无论是在结构性心脏病患者,还是在心脏结构正常的患者,蒲肯野纤维起源的触发灶经常可诱发心室颤动。另外,临床上许多单形性室性心动过速(室速)以蒲肯野纤维为折返环。对于蒲肯野纤维相关的单形性或多形性室性心律失常,以异常蒲肯野电位为靶点的导管消融往往十分有效。Cardiac Purkinje fibers are the most distal component of the conduction system,which are responsible for the synchronous activation of the ventricles.However,Purkinje fibers are highly arrhythmogenic due to their anatomic complexity and unique cell ultrastructure,cell electrophysiology,and mode of excitation-contraction coupling.Purkinje fibers are not only involved in automatic and triggered focal rhythms,but also in reentrant arrhythmias.In humans,Purkinje-originated triggers often induce ventricular fibrillation in a large spectrum of patients with structural heart disease or with an apparently healthy heart.Moreover,a variety of monomorphic ventricular tachycardias are generated using Purkinje fibers as the critical reentrant circuit.Catheter ablation targeting Purkinje potential is a very effective treatment for patients with monomorphic and polymorphic Purkinje-related ventricular tachycardias.

关 键 词：蒲肯野纤维 室性心律失常 离子通道 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]