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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Concealed left pulmonary vein potentials unmasked by left atrial stimulation.
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Concealed left pulmonary vein potentials unmasked by left atrial stimulation.

机译：左心房刺激掩盖了隐藏的左肺静脉电位。

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摘要

Pulmonary vein potentials (PVPs), though obvious during ectopic activity, are frequently invisible during sinus rhythm when they need to be distinguished from left atrial (LA) potentials to perform successful ablation procedures. Thirty-six patients with paroxysmal atrial fibrillation underwent circumferential PV mapping with a circular ten-electrode catheter during sinus rhythm, and during pacing from the right atrium, proximal and distal coronary sinus (CS), and LA. Ablation was performed at the ostium of the PV, the procedural endpoint consisting of electrical disconnection of the PV from the LA. A total of 93 PVs (excluding the right inferior PV) were mapped. During sinus rhythm, distinct right PVPs were present in all instances, while they were concealed within the electrograms recorded from the left inferior and superior PV in 23 (64%) patients. Distal CS or LA appendage pacing unmasked and separated left PV from LA potentials by a mean of 19 +/- 14 ms; the LA-to-left-PV potential interval measured 36 +/- 14 ms. The number of deflections also increased from 2.1 +/- 0.7 during sinus rhythm to 3 +/- 1.4 during LA stimulation. However, in the right superior PV, pacing caused overlapping of atrial potentials with right superior PVPs. RF ablation of the left PVPs was performed during distal or LA pacing in 23 patients, while in the right superior PV it was performed during sinus rhythm eliminating all, including unmasked, left PVPs, providing proof of their PV origin. Distal CS or LA pacing is required to recognize left PVPs in approximately 2/3 of patients and facilitates RF ablation.
机译：肺静脉电位（PVP）尽管在异位活动中很明显，但在窦性心律中经常不可见，因此需要将它们与左心房（LA）电位区分开来进行成功的消融手术。三十六例阵发性心房颤动在窦性心律，右心房，近端和远端冠状窦（CS）和LA起搏期间，使用圆形十电极导管进行圆周PV定位。切除是在PV的口处进行的，该过程的终点是PV与LA的电断开。总共绘制了93个PV（不包括右下方的PV）。在窦性心律期间，在所有情况下均存在明显的右PVP，而在23例（64％）患者的左下和上PV记录的电描记图中隐藏了它们。远端CS或LA附肢起搏未掩盖，并且将左PV与LA电位平均隔开19 +/- 14毫秒; LA到左PV的电位间隔为36 +/- 14 ms。偏转次数也从窦性心律期间的2.1 +/- 0.7增加到LA刺激期间的3 +/- 1.4。但是，在右上PV中，起搏导致右上PVP与心房电位重叠。左PVP的射频消融在23例患者的远端或左心室起搏期间进行，而右上PV在窦性心律下进行，消除了所有（包括未掩盖的左PVP），从而提供了其PV起源的证据。需要远端CS或LA起搏才能识别大约2/3的患者中的左PVP，并有助于RF消融。

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