Study of underlying mechanism of chronic atrial fibrillation and development of new less invasive surgery

慢性心房颤动的潜在机制研究及新型微创手术的开发

基本信息

批准号：
10470275
负责人：
SUEDA Taijiro
金额：
$ 7.36万
依托单位：
HIROSHIMA UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B).
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 2000
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-10470275/
关键词：
atrial fibrillation maze procedure electrophysiological study earliest activation time fast Fourier transform PVO isolation less invasive surgery Backman束電位

项目摘要

To examine the electrophysiological characteristics of chronic atrial fibrillation associated with valvular disease, electrical activity of atrial fibrillation was mapped on the atrial surface by means of multi-point electrodes and specially made mapping system. Data were mainly acquired from the atrial free wall of both atria and anatomical obstacles, such as the orifice of pulmonary veins, and were analyzed using specially designed software. In this study, "macroreentry" was not detected but other new propagation patterns were found. Using spectral analysis, electrophysiological difference was noted between both atria. These findings suggest that early activation occurred from the left atrium and propagated to the right atrium and thus chaotic activation pattern was formed in the right atrium because of unequal refractory period on the right atrium.We developed a new, more simple surgical procedure, named as "pulmonary vein orifice isolation procedure", based on these electrophysiological findings. To eliminate chronic atrial fibrillation, we performed this procedure associated with mitral valve surgery and successfully set these patients, then, more than 80% of these free from atrial fibrillation postoperatively. Large left atrial dimension and long duration of preoperative atrial fibrillation was the predictive factor for the recurring atrial fibrillation. Small difference of electrophysiological status in both atria also predicted postoperative outcome. From the echocardiographic examination, posloperative cardiac performance was excellent in those cases who regained sinus rhythm and left atrial kick in the transmitral flow was observed in the majority of those patients.

为了检查与瓣膜疾病相关的慢性心房颤动的电生理特征，通过多点电极和专门制作的映射系统，将心房颤动的电活动映射在心房表面上。数据主要是从心房和解剖障碍物（例如肺静脉孔口）的心房壁中获取的，并使用特殊设计的软件进行了分析。在这项研究中，未检测到“大探探”，但发现了其他新的传播模式。使用光谱分析，两个心房之间都发现了电生理差异。这些发现表明，早期激活是从左心房发生的，并传播到右心房，因此在右心房中形成了混乱的激活模式，因为在右心房上的不平等耐磨期不相等。我们根据这些电力学发现了一种新的，更简单的外科手术，被称为“肺部静脉孔分离程序”。为了消除慢性心房颤动，我们执行了与二尖瓣手术相关的程序，并成功地设置了这些患者，然后，其中80％以上的术后不含心房颤动。较大的左心房维度和术前房颤的持续时间是反复发生的房颤的预测因素。两个心房的电生理状况的微小差异也预测了术后结果。从超声心动图检查中，在大多数患者中观察到了鼻窦节律并留下心房流动中心房踢的情况下，心脏表现非常出色。