Electrical connections between left superior pulmonary vein, left atrium, and ligament of Marshall: implications for mechanisms of atrial fibrillation
| Autor: | Peng Sheng Chen, Michael C. Fishbein, Motoki Nihei, Chun Hwang, Alex Y. Tan, C. Thomas Peter, Chung Chuan Chou, Shengmei Zhou |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
Cardiac pacing Physiology Left atrium Dogs Heart Conduction System Physiology (medical) Internal medicine Atrial Fibrillation Left superior pulmonary vein medicine Animals Heart Atria Ligaments Extramural business.industry Cardiac Pacing Artificial Atrial fibrillation Anatomy medicine.disease Electrophysiology medicine.anatomical_structure Pulmonary Veins Ligament Cardiology Atrial Function Left Cardiology and Cardiovascular Medicine business Heart atrium |
| Zdroj: | American Journal of Physiology-Heart and Circulatory Physiology. 290:H312-H322 |
| ISSN: | 1522-1539 0363-6135 |
| DOI: | 10.1152/ajpheart.00369.2005 |
| Popis: | The importance of the ligament of Marshall (LOM) to rapid activations within the left superior pulmonary vein (LSPV) during atrial fibrillation (AF) remains poorly understood. We aimed to characterize the importance of electrical coupling between the LSPV with the left atrium (LA) and the LOM in the generation of high-frequency activations within this PV. We performed high-density mapping of the LSPV-LA-LOM junction in eight dogs, using 1,344 electrodes with a 1-mm resolution before and after posterior ostial ablation to diminish PV-LA electrical connections. A LOM potential was recordable up to 6.5 mm (SD 2.2) into the LSPV in all dogs during sinus rhythm (SR) and LA pacing. Functional LOM-LSPV electrical connections bypassing the PV-LA junction were present in five of eight dogs. Direct LOM-LSPV connections contributed to 46.5% (SD 16.0) of LSPV activations during AF, resulting in a greater propensity to develop focal activations ( P < 0.05) and a higher activation rate during AF of LSPVs with direct LOM connections compared with those without ( P < 0.03). Posterior LSPV ostial ablation without damaging the anterior wall or LOM slowed residual LA-PV conduction ( P < 0.001). This diminished PV-LA coupling prevented the reinduction of LSPV focal activations in all dogs. However, persistent LOM focal activations in two dogs continued to activate the LSPV rapidly [cycle length 151.8 ms (SD 4.8)] via direct LOM-LSPV connections. LOM-LSPV connection forms an accessory pathway that contributes to the electrical coupling between LSPV and LA during SR and AF. This pathway may contribute to rapid activations within the LSPV during AF. |
| Databáze: | OpenAIRE |
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