房室結節及びヒス束に関わる形態計測上の諸項目の中で,何が同領域のアブレーション効果に大きな影響を与えるか

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It is known that the electrical energy required for effective electrical ablation of the atrioventricular node (AVN) and His bundle (H) to control severe arrhythmias is subject to considerable interindividual variation. We hypothesized that the location of the AVN and H in the septal tissues of the hearts of different subjects vary considerably and investigated which morphometric parameters of the AVN and H are critical for effective electrical ablation by conducting light-micro-scopic morphometry of 10 parameters at 5 levels (see Common abbreviations for figures) of the septal tissue of semi-serial sections of 7 human hearts of almost identical external sizes with no gross pathology. We also mapped the courses of the AVN and H and depicted other non-morphometric parameters, such as the features of the tissues around them. When evaluating these parameters, we noted three dimensional elements as follows: the first element was a perpendicular line from the opening of the coronary sinus (CS) to the tricuspid annulus (i,e., the base of the septal cusp of the tricuspid valve; BSCT); the second was a line along the BSCT and the third was a depth from the endocardium of the right/left atrium/ventricle (Fig. 1). The AVN and H varied markedly in all three dimensions and their topographical relationships with the membranous part of the atrial/ventricular septa (MS) also varied (Figs. 2-5). The AVN and H were often located on the right atrial/ventricular side and ran along most of the posteroinferior margin of the MS (MS type). However, they sometimes ran through the fibrous skeleton of the heart from the right atrial-side to the left ventricular side away from the MS (L type). Their topographical relationships with the fibrous skeleton and/or fatty tissue varied according to the level examined, but their features in each level was constant in all specimens. ?In spite of the almost identical external sizes of the cardiac specimens, the morphometric parameters along the first and second dimensional elements (Table 1) varied considerably with each parameter by more than 5 mm, whereas those along the third element (Table 2), i.e., their depth, only varied by about 2-3 mm among specimens and at different levels. Consequently, we concluded that the considerable variations in electrical energy required for effective ablation do not depend on the depth and/or non-morphometric parameters on the AVN and H, but do depend on the parameters along the first and second domensional elements, i.e., variations in the locations of the target in relation to the right atrial/ventricular wall.
札幌医科大学の論文
1999-12-01

房室結節及びヒス束に関わる形態計測上の諸項目の中で,何が同領域のアブレーション効果に大きな影響を与えるか

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