犬Marshall韧带在心房颤动中的作用机制  

Re-entry hypothesis testing within ligament of Marshall as a mechanisma for sustaining atrial fibrillation in dogs

作　　者：卢春山[1] 方冬平[1] 张爱国 郝蓬[1] 何东方[1] 赵林[1] 迟云鹏[1] 马克娟[1] 张瑜[1] 李巧元[1] 信满坤 林璨璨 郭成军[1] 刘兴鹏[1] Lu Chunshan;Fang Dongping;Zhang Aiguo;Hao Peng;He Dongfang;Zhao Lin;Chi Yunpeng;Ma Kejuan;Zhang Yu;Li Qiaoyuan;Xin Mankua;Lin Cancan;Guo Chengjun;Liu Xingpeng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,100029

出　　处：《中华胸心血管外科杂志》2018年第9期548-551,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨Marshall韧带（LOM）在心房颤动（房颤）中的作用机制。方法对9只健康杂种雄犬行电生理学检查，其中健康杂种犬4只（A组），持续性房颤犬5只（B组）。测定两组犬LOM电生理学及组织学特征，标测是否存在折返环特征，对比并作统计学处理。外科干预LOM，对比干预前、后两组犬的电生理学特性变化。结果两组LOM异常电位发生比例有显著性差异（P〈0.01）：折返环发生比例（A组25%，B组80%），心动过速（A组25%，B组100%），双电位（A组25%，B组80%），碎裂电位（A组25%，B组80%）。干预前、后B组LOM心动过速诱发比例差异有统计学意义（P〈0.05，干预前100%，干预后20%）。结论LOM参与房颤发生和维持的两种可能机制：一是LOM通过自发激动诱发房颤；二是以旁路形式参与左心房与肺静脉之间的折返，诱发和维持房颤。Objective To explore the mechanisms of ligament of Marshall（LOM） initiat and sustain atrial fibrillation（AF）.Methods The electrophysiologic properties of canine LOM were investigated using multipolar catheter mapping（normal canines, n=4, group A; AF canines, n=5, group B）. The programmed stimulation were performed in the LOM, PV-left atrium（LA）junction and LA, respectively. Activations maps of LOM were analyzed from episodes of spontaneous onset of AF and initiation of induced AF by a single extrastimulus. The effectives refractory period of each part was compared and statistically analyzed among three parts in each group and between the two groups. LOM were cutted with surgical incision technology. The inducing rate of AF and the mapping rate of double potential and fragmented electrocardiogram were compared and statistically analyzed pro and post isolation of LOM.ResultsThe incidence of abnormal potential of LOM in the two groups was significantly different（P〈0.01）, re-entry cycle（group A 25% vs. B group 80%）, tachycardia（group A 25% vs. B 100%）, double potential（group A 25% vs. group B 80%）, fragmentation potential（group A 25% vs. group 80%）. There was a significant difference in the rate of LOM tachycardia induction before and after LOM intervention in group B（P〈0.05, before 100% vs. after 20%）.ConclusionThere are two possible mechanisms of LOM involved in the occurrence and maintenance of AF： one is that LOM induces AF through spontaneous excitation, the other is that LOM participates in the reentry of left atrium and pulmonary vein in the form of bypass to induce and maintain AF.

关 键 词：心房颤动 MARSHALL韧带 折返 标测 左心房 

分 类 号：R541.75[医药卫生—心血管疾病]