电生理标测下的希浦系统分布特点研究  

Study on Distribution Characteristics of His-Purkenje System Under Electrophysiological Mapping

作　　者：邓晓奇 熊峰 汪汉 杨国澍 罗端 蔡琳 DENG Xiaoqi;XIONG Feng;WANG Han;YANG Guosu;LUO Duan;CAI Lin(The Affiliated Hospital of Southwest Jiaotong University,The Third People's Hospital of Chengdu,Chengdu 610031,Sichuan,China)

机构地区：[1]西南交通大学附属医院成都市第三人民医院,四川成都610031

出　　处：《心血管病学进展》2021年第7期653-657,共5页Advances in Cardiovascular Diseases

基　　金：成都市卫生健康委员会项目(20PJ201)。

摘　　要：目的通过电生理标测希氏束、左右束支及其分支的长度和宽度,明确希浦系统的分布及区域特点,为希浦系统区域起搏提供理论依据。方法选取行心内电生理检查及射频导管消融,且无基础心脏疾病的8例患者,逐点标测希氏束电位及左右束支电位,分析并测量:希氏束分布的长度和宽度;左前分支和左后分支分布的长度和宽度;希氏束与最早出现左束支电位的距离。结果希氏束长度区域为5.4~24.2 mm,平均15.9 mm;宽度区域为7.8~11.6 mm,平均9.6 mm;长度的差异度更明显。左前分支长度区域为28.8~35.6 mm,平均31.3 mm;宽度区域为8.0~17.6 mm,平均13.1 mm。左后分支长度区域为22.2~62.1 mm,平均45.1 mm;宽度区域为9.4~31.7 mm,平均18.1 mm。不管是分布长度还是宽度,左前分支与左后分支无统计学差异。希氏束与左前分支的距离范围为31.8~61.2 mm,平均44.4 mm;到左后分支的距离为43.0~78.6 mm,平均59.4 mm。结论电生理标测的希浦系统区域远大于希浦系统解剖区域;左束支分布区域大,在左束支区域起搏可解剖学定位;若以希氏束定位,左束支区域起搏范围建议距离希氏束3~4 cm。Objective To determine the distribution and regional characteristics of His-Purkenje system by electrophysiological mapping of the length and width of His bundle,left and right bundle branches and their branches,so as to provide theoretical basis for regional pacing of His-Purkenje system.Methods Eight patients without underlying heart disease who underwent intracardiac electrophysiological examination and radiofrequency catheter ablation were selected.His bundle potential and left and right bundle branch potential were measured point by point.The length and width of His bundle distribution,the length and width of left anterior and left posterior branches,and the distance from His bundle to the earliest left bundle branch potential were analyzed and measured.Results The length of His bundle ranged from 5.4~24.2 mm,with an average of 15.9 mm;the width ranged from 7.8~11.6 mm,with an average of 9.6 mm.The difference of length is more obvious.The length of left anterior branch was 28.8~35.6 mm,with an average of 31.3 mm;the width was 8.0~17.6 mm,with an average of 13.1 mm.The length of the left posterior branch was 22.2~62.1 mm,with an average of 45.1 mm;the width was 9.4~31.7 mm,with an average of 18.1 mm.No matter the length or width of the distribution,there was no significant difference between the left anterior branch and the left posterior branch.The distance from His bundle to left anterior branch was 31.8~61.2 mm,with an average of 44.4 mm;the distance from His bundle to left posterior branch was 43.0~78.6 mm,with an average of 59.4 mm.Conclusion Electrophysiological mapping of the His-Purkenje system is much larger than the anatomical His-Purkenje system;the distribution area of left bundle branch is large,and pacing in the left bundle branch area can be anatomically located;if His bundle is mapping,the pacing range in the left bundle branch area is recommended to be 3~4 cm away from His bundle.

关 键 词：希浦系统 希氏束 电生理 心脏起搏 

分 类 号：R54[医药卫生—心血管疾病]