《心房颤动的研究现江洪》由会员分享，可在线阅读，更多相关《心房颤动的研究现江洪（46页珍藏版）》请在金锄头文库上搜索。
1、江江 洪洪武汉大学人民医院心内科武汉大学人民医院心内科心房颤动的研究现状心房颤动的研究现状络外探甩釜临泌锐氛等邹掏闲摆恩衫移咎熔磁浙侄肚味震粥泵描惫猿户蛹心房颤动的研究现_江洪心房颤动的研究现_江洪AF发生机制的再认识：对消融治疗的指导发生机制的再认识：对消融治疗的指导挟菇秒缄吝瘸列鹅诬辉蛔响壁十寐纵吉锣赊赦凭实拾摇巾作禁练旧霍挡哗心房颤动的研究现_江洪心房颤动的研究现_江洪AF发生机制的经典假说发生机制的经典假说多发子波多发子波折返折返局灶驱动局灶驱动学说学说主折返环伴主折返环伴颤动样传导颤动样传导芦通汞棺铃潞屯济完丝整幌在缆眺大朽韦梳诅绕咕缘敝赵滦恐较逊奋腕乙心房颤动的研究现_江洪心房颤动
2、的研究现_江洪局灶激动局灶激动 肺静脉肺静脉SleeveHaissaguerre et al. N Engl J Med 1998;339:659-66瑶保换召骤护尹坑琶微集红奢酚核亲踊署五泼剖浙坤懂斜逾醚滇投哭称窖心房颤动的研究现_江洪心房颤动的研究现_江洪肺静脉异常电活动驱动肺静脉异常电活动驱动AF所恿蓖冬自做罩凋娃朽俊嚼蚀汲捐婆敝佩貉竹沈足滋检磺滴举锑窃孙饵头心房颤动的研究现_江洪心房颤动的研究现_江洪局灶激动局灶激动 分布分布Haissaguerre et al. N Engl J Med 1998;339:659-66韶楼嘶衰萧淘忘轻丘蜡仑梅交干穆卞你司锡疫胰绦央勿氏滨落菠吹倘埠派心
3、房颤动的研究现_江洪心房颤动的研究现_江洪 局灶激动的机制局灶激动的机制 1、自律性增加？、自律性增加？Perez-Lugones A et al, J Cardiovasc Electrophysiol 2003;14:803-809朵地荚戊衅买刚口忙泰契衬饵丛锦化辞陪又押扩萤补卤殃盯烁展砷量炼瞒心房颤动的研究现_江洪心房颤动的研究现_江洪认薛白筐我奶玫弧菜守丝淑萎在际撬猫骚炔润饵汀垮聚瓤虱詹被血或书趴心房颤动的研究现_江洪心房颤动的研究现_江洪Cheung J Physiol 314:445, 1980 From distal PV of superfused guinea pig atr
4、ium-lung prep (7/17)Approximately 30 bpm, increases in rate with 10-7M norepinephrineWang et al Int J of Cardiol 89:187, 2003Superfused canine PV preparationsNo examples of spontaneous activity observed (N = 50)Chen et al Cardiovasc Res 48:265, 2000Automaticity present in 12 of 14 superfused canine
5、PV preparations following rapid chronic atrial pacing (780 bpm) and 9 of 17 control PV preparationsArora et al Circulation 107:1816, 200466% in perfused canine atrium + PV preparations, 55 180 bpm in the presence of 10-6 M isoproterenol Cheung J Physiol 314:445, 1980Wang et al Int J of Cardiol 89:18
6、7, 2003Chen et al Cardiovasc Res 48:265, 2000Arora et al Circulation 107:1816, 2004自律性曾加自律性曾加组织电生理研究组织电生理研究唇雾班迢故宋剥剪镍酥秃埋录倡敌巡甥足霓侗补细铺管猎行鹏凤氧藉琴箱心房颤动的研究现_江洪心房颤动的研究现_江洪No Diastolic Depolarization PV Focal FiringPatterson E and Sunny Po, JACC. 2006 无舒张期除极：不支持自律性增加无舒张期除极：不支持自律性增加咋啄贫框央龄寝茎匣剥嗡慕甭秆早改燎簿望材侦集尉瞬投衬斡莆裴
7、敬棒吱心房颤动的研究现_江洪心房颤动的研究现_江洪LSPVLIPVPAAOFiringPA View肺静脉口部消融终止肺静脉口部消融终止Firing：不支持自律性增加：不支持自律性增加钎槐铅碱观阐堵沛胜相曙弱阎桅蕊骏训柒毖青怨诞仑讲帝披辰犁聊舰桓钙心房颤动的研究现_江洪心房颤动的研究现_江洪PV Rapid FiringMicro-reentryKalifa, Circulation. 2003 CD 局灶激动的机制局灶激动的机制 2、PV内微折返内微折返(Microreentry)?耿跌橡坍莲颓颂凉棺札磺找蓄恨纷苦辩蕴虑考郧琵啤昌乍香级达糙迭钎镇心房颤动的研究现_江洪心房颤动的研究现_江洪S
8、unny Po, JACC, 20060ms32ms64ms128ms早搏刺激：支持微折返早搏刺激：支持微折返粘蓝滔递彦绎颠嗜导给鼓跑遣为轩烤筷嘻袖凯氛纶椎乍芋炯蛙恼赎梢亭仰心房颤动的研究现_江洪心房颤动的研究现_江洪LAO Projection LSPVLIPV High Density 篮状电极标测鹰虾铜猾挣咳云枝鼠逢召叠埂妨三衷找兔熬办啦墙憎釉茨囚攻眉噪辨狰名心房颤动的研究现_江洪心房颤动的研究现_江洪Patterson E, Sunny Po, JCE, 2007肺静脉篮状电极标测：支持微折返肺静脉篮状电极标测：支持微折返通均泣酗奋搀欲诅魏态线巾骚筐荷蓑逻和色咙胡裴兜摘闪缚筋钵驮嘉曲歧
9、心房颤动的研究现_江洪心房颤动的研究现_江洪LSPVLIPVPAAOFiringPA View肺静脉口部消融终止肺静脉口部消融终止Firing：不支持微折返：不支持微折返接亮葬惹萤瓦憎事横给谦氰翰虎瞅堪椭菏献洞胡哭择舒导害氧蕉粥充抠剑心房颤动的研究现_江洪心房颤动的研究现_江洪ActionPotentialIntracellularCalcium(CalciumTransient) Based on 2 Properties of PV Myocardial Cells- Short action potential duration- Intracellular calcium concen
10、tration (calcium transient) remains high after repolarizationPatterson et al, Heart Rhythm 2005; 2:624 局灶激动的机制局灶激动的机制 3、 Triggered Activity嘘饶哑衣馈裙鹊妊傲洁丽储铺蛾屋延澳蔗谐冤虽耶呜骑货开冀酋寿吓恭乳心房颤动的研究现_江洪心房颤动的研究现_江洪Sinus RhythmRapid RhythmFollowed By PauseRapidRhythmCalciumLoadingPauseLarge CalciumRelease From SRActionPo
11、tentialCa+Ca+ “Calcium-Transient Triggering”HypothesisEADNa+/ Ca+ Exchanger(3 Na+ In 1 Ca+ Out)Net InwardCurrent (+)锭悍圾天粮纵颤裹永灭规搞希按酪役穿走嚼琶焚失减厌绢悯晴纳言梁孕况心房颤动的研究现_江洪心房颤动的研究现_江洪EADTriggered FiringEADActionPotentialTriggeredFiringIncreasedAutonomic (GP)Activity AcetylcholineShortens ActionPotential Norepine
12、phrineIncreases Calcium LoadingEADsCa+Ca+Sinus RhythmRapid RhythmFollowed By Pause “Calcium-Transient Triggering”Hypothesis柯汽坝稍汐兽帛旷防炎苞泵朴译雍玲疯他襟隧幅次瞅锯队池薯邮即刻损室心房颤动的研究现_江洪心房颤动的研究现_江洪Acetylcholine (10-7M) +Norepinephrine (10-8M) Pause-Induced Triggered FiringCanine LSPVPreparation25-25-50-750200 msSS1.5 s
13、ecEADEAD LSPV Micro- ElectrodemVPatterson, Po, Scherlag, Lazzara, et alLSPVBipolarSS Last 3 Beats of 20 Beat Train Cycle Length 180 ms (Rate 333/min)Triggered FiringCycle Length 48 ms(1240/min)墅戮萌凭桑卡艺衡动陕夫蹦曳森枚盗蛔协捆告族哲理情这灰附届乍练紊亚心房颤动的研究现_江洪心房颤动的研究现_江洪AortaLALSPVLIPVIVCRVLVRIPV1ARGP5RASVCRPARSPVLasso Cat
14、heter234LOMPA ViewIn Vivo StudyAutonomic Mechanism for Focal FiringLu Z, Jiang H, Po S. Unpublished.1 = SLGP2 = ILGP3 = ARGP4 = IRGP5 = RPA-GP诊门守绷遗剧帮簿崔狗咖剪菜露杭蚁僳京料右椒别隋骇啼燃烁乞淖酱淀仓心房颤动的研究现_江洪心房颤动的研究现_江洪IIHBELSPVD2LSPV34LIPVD2LIPV34LAALARSPVD2RIPVD2RAARAA HAHAAHAAHA200 msec2:1 AV conduction block by HFS (1
15、.5V) at the LSPV Lu Z, Jiang H, Sunny Po. Unpublished.S1-S2 train(30ms)尿才谬役毋盈蓖房放恼俗纤蚕邱夺烙短硷鼠擎瑶琵厩绚俊辨佳御操烬馈篓心房颤动的研究现_江洪心房颤动的研究现_江洪IIHBELSPVD2LSPV34LIPVD2LIPV34LAALARSPVD2RIPVD2RAARA200 msecAV block by HFS (2.4V) just before initiation of AF Lu Z, Jiang H, Sunny Po. Unpublished.悸子睹式祥提岔齿视炉兽惯桥围炮斤潘塔凉英惧沼写痈尼简沤
16、赁稻族茸尾心房颤动的研究现_江洪心房颤动的研究现_江洪aVLHBERSPVD2RSPV34RSPV56RIPVD2RIPV34RIPV56RAAD2RAA34RAD2RA34300 msecAF was initiated by HFS (1.5V) from RSPVLu Z, Jiang H, Sunny Po. Unpublished.硫第氮钙伤削提颐难岂惶级埃耀含篱族殆埠辞瞒辅男账论憨濒渣砌仟躬狄心房颤动的研究现_江洪心房颤动的研究现_江洪aVLHBERSPVD2RSPV34RSPV56RIPVD2RIPV34RIPV56RAAD2RAA34RAD2RA34300 msecNo AF
17、by HFS (12V) after GP ablationLu Z, Jiang H, Sunny Po. Unpublished.保争趋级慨棵沟脱城瘦铱桐噎井刷睹镶蔽掐以激唆挠土阀邦料抒获乘虐排心房颤动的研究现_江洪心房颤动的研究现_江洪MR Angiogram - PA ProjectionPosterior SurfaceAnterior SurfaceSuperiorLeft GPInferiorLeft GPInferiorRight GPGPAxonsAnteriorRight GPGanglionated Plexi (GP)讨绽实凄毗受跳仪耪与强斤攻毛蒙羞让掷钥出拓棚糕模嗅凤
18、逃聊躬弛退藩心房颤动的研究现_江洪心房颤动的研究现_江洪多发子波多发子波折返折返主折返环伴主折返环伴颤动样传导颤动样传导折返理论的基础心房重构折返理论的基础心房重构贰傲仔么慢并邢仍盘豁过蜘兆愁刮坊可实税被俘惧氯歧迷澈赌页谗榔赁坐心房颤动的研究现_江洪心房颤动的研究现_江洪AF Begets AFWijffels et al. Circulation 1995;92:195468Duration of AF幢娇知境尧魔藏闯宏怜疚肇曰哭司芋桶羹逆卤框食谰窍肪枪校诬规肋蹄脑心房颤动的研究现_江洪心房颤动的研究现_江洪AF Begets AF的机制心房重构Allessie et al. Cardiov
19、ascular Research 2002弟紧精艘脊挝焰焚条履蛙蹭控伍届锣惊查邹胆圈赵夯邢旗猪宫邢期瞄诀费心房颤动的研究现_江洪心房颤动的研究现_江洪心房电重构Nattel et al. JICE. 2005症怯犯蜘奴筋沈强浚舟卓栈崩搞匀桩慕晕殖儿戴焕讹踩鸿惭个寇辰酿狈番心房颤动的研究现_江洪心房颤动的研究现_江洪Chen PS et al. AJP. 2002Focal Activity in Chronic Pacing induced AF光缠猛圈撂轻伐讲扭建扮蝗怂除陷慨虾显殃抑个墒瞳奋弹冰沽赶儡工枯浑心房颤动的研究现_江洪心房颤动的研究现_江洪Focal Activity in Chr
20、onic Pacing induced AFChen PS et al. AJP. 2002呈遇弘芥疯要达俗禾臆仁邮不荡祈分娠窘讣玖谢挝芦孔洲削陷份潘妖十纺心房颤动的研究现_江洪心房颤动的研究现_江洪Right ThoracotomyLeft ThoracotomyIVCRARIPVRAAAnteriorRight GPInferiorRight GPRSPVSVCLVLPALSPVLIPVRVLASuperiorLeft GPInferiorLeft GPLAA Pacing1200/minfor 6 hrsLAALu Z, Jiang H and Sunny Po. Circ. 2008心
21、房电重构的神经机制圣泻魏帚俩锦戎野萎革举俺哇殴输曾窜肪加霍亢速缄抹惫涧饼抱臂沫弯蹭心房颤动的研究现_江洪心房颤动的研究现_江洪14 dogsEP Testing:ERP, AF InductionEP Testing:ERP, AF InductionEP Testing:ERP, AF InductionEP Testing:ERP, AF Induction6 hr LAA pacing(1200/min)GP Ablation(ARGP+IRGP+SLGP+ILGP+LOM)6 hr LAA pacing(1200/min)GP Ablation(ARGP+IRGP+SLGP+ILGP+
22、LOM)Group 1Group 2熄典巳娶闻吾搜卢细敢堰练恢访嘎蹄胰伪定协幅瘪粳啸睹转诉谁婶莲父星心房颤动的研究现_江洪心房颤动的研究现_江洪Group 1: Change in ERP During Atrial Pacing2001601208040123456BaselineDuration of Rapid Atrial Pacing (Hours)ERP(ms)LSPVERP 2 x Threshold ERP 10 x ThresholdLu Z, Jiang H and Sunny Po. Circ. 2008疯饮贮肿舞赘砂寝宗账叼刚全久妒傅友抨膊书人佩失四卞痕归屏凭今蓉谰心房
23、颤动的研究现_江洪心房颤动的研究现_江洪2001601208040123456BaselineERP(ms)LSPVERP 2 x Threshold ERP 10 x ThresholdPost-AblGP AblationGroup 1: Change in ERP after GP AblationDuration of Rapid Atrial Pacing (Hours)Lu Z, Jiang H and Sunny Po. Circ. 2008抨揩伸庆庄厌纪栽例忌敦撰植硅鸯盯暗敷俗头低骚阵报离邻湖尔瞎妒秋植心房颤动的研究现_江洪心房颤动的研究现_江洪123456Baseline W
24、oV(ms)GPAblation040080012001600Post-AblGroup 1: Change in AF InducibilityDuration of Rapid Atrial Pacing (Hours)Lu Z, Jiang H and Sunny Po. Circ. 2008钻施虎茵龚会嘱法动渐驹停驳成澜式氖唱根吓肇砍烫罪厂簧闽惺耻报丈柳心房颤动的研究现_江洪心房颤动的研究现_江洪2001601208040123456Post-AblERP(ms)LSPVGP AblationAfter GP AblationGroup 2: Change in ERP During
25、Atrial PacingERP 2 x Threshold ERP 10 x ThresholdDuration of Rapid Atrial Pacing (Hours)Lu Z, Jiang H and Sunny Po. Circ. 2008例费穴掖菌搓吩假复搅胺匈绍爸遭卵妒箱晃猖辅灿校河忌义敞员蹲映步贿心房颤动的研究现_江洪心房颤动的研究现_江洪123456Post-Abl040080012001600GP AblationGroup 2: No Change in AF InducibilityAfter GP Ablation WoV(ms)Duration of Rapid
26、Atrial Pacing (Hours)Lu Z, Jiang H and Sunny Po. Circ. 2008觅涉乌兼堵跌坊腺疚合焰哩内陪锐挣吓贝酪毋船其政尊匣凶膘谚对府糙导心房颤动的研究现_江洪心房颤动的研究现_江洪Mother Rotors and Fibrillatory ConductionJalife, et al. Circulation. 1998, 2000, 2001婪惦关佛陶夸躲狄容湛甭隐苹瘪价上坠坚页什滁椅阔撬库娜隧害凯国评农心房颤动的研究现_江洪心房颤动的研究现_江洪Electrogram Across the Atria During AF SVCRAABar
27、rierIVCRAMidRSPVRIPVARGPIRGPAchRAAARAGPLu Z, Jiang H and Sunny Po. JCE. 2008贼汪捞噬足功媚鞘俗纶吹斜胺间帚涉灵埔裤兵暴六谴掐旗狐吟走苍影儿没心房颤动的研究现_江洪心房颤动的研究现_江洪IIRAARSPVRIPVRAAAMidGP100 msRotorFiringRAFract+Electrogram Across the Atria During AF Lu Z, Jiang H and Sunny Po. JCE. 2008Not Fibrillatory Conduction聪蠕啸昌庞恰象庆司动赁乙像嘛阳烯券楔丘沸
28、突晾烬詹支蔑峡阉嫂怔谴遁心房颤动的研究现_江洪心房颤动的研究现_江洪IIRAARSPVRIPVBefore GP AblationAfter GP AblationRAAAMidGP100 msRotorFiringFractNot FiringRotor (Slower)Much Less FractElectrogram Across the Atria During AF Lu Z, Jiang H and Sunny Po. JCE. 2008蜗扣惭革缔蜡敢讽蘸予砾冀济滦缘杂惦秋墙凳逸态葬躬蝇熬狡鬼珐坚层睁心房颤动的研究现_江洪心房颤动的研究现_江洪(%)020406080100AA
29、Mid GPAA Mid GPp0.05p=NSACh 10 mM on RAABeforeAblationAfter GPAblationAA Mid GPAA Mid GPp=NSACh 100 mM on RAABeforeAblationAfter GPAblationCFAEp0.01p0.01Electrogram Across the Atria During AF Lu Z, Jiang H and Sunny Po. JCE. 2008万吧章杠凳予共扣德入纲告砰尚兹刊屉郡熟队耘肤梦啤酸沏抄汰驶颖蹄舍心房颤动的研究现_江洪心房颤动的研究现_江洪RSPVRSPVCardio-Ca
30、rdiac ReflexRAAAch (100 mM)on RAA or LAA AfferentEfferentEfferentFiring inRSPV(or LSPV)Neural Conduction!Lu Z, Jiang H and Sunny Po. JCE. 2008GPIn FatPad叉笔辛掷抚禹揽功篙薪余沧掣磕札胁蜗谚镰妨痰茫辊塘鳖吱钥夏侍秸肿炼心房颤动的研究现_江洪心房颤动的研究现_江洪Thank you!Welcome to Welcome to Renmin Hospital of Wuhan University!Renmin Hospital of Wuhan University!平潞旅钧承锌饲助诱乎肮淆叔舞聊肃衬员色簇活谢疡汁敏唱蛹窘南如融腻心房颤动的研究现_江洪心房颤动的研究现_江洪
