| Part I The Anatomic and Histological Study of Chinese Coronary Sinus Muscular Sleeve and Its Connection With the Left AtriumObjective: To investigate the anatomic and histological features of Chinese coronary sinus muscular sleeve and its connection with the left atrium. Methods: 7 necropsied hearts were studied by performing serial longitudinal sections paralleled to the long axis of the coronary sinus and were observed using a large microtome. Results: The muscular sleeve existed in all specimen. Length was 21 ~ 35mm. Thickness was 0.2 ~ 1.7mm. The muscular connection between the coronary sinus and the left atrium also existed in all specimen. In 5 specimen, the connections were composed of multiple muscular bundles and were tightly and indistinguishable with each other. In 2 specimen, the connections were composed of only 1 ~ 2 large muscular bundles, and many small muscle bundles were observed in theadipose tissue between the coronary sinus and the left atrium. Conclusion: Abundant muscular sleeves existed in the coronary sinus, and the connections between the left atrium and the coronary sinus were varing largely in number and form. These muscular sleeves and connections constitute a conduction route between the inferiors of the right and left atrial. PART II The Experiment Study of Blocking the Electrical Conduction Path of Coronary Sinus by Radiofrequency AblationObjective: To investigate the method and possibility of blocking the electrical conduction path of coronary sinus by radiofrequency ablation. Methods: After radiofrequency ablation in coronary sinus, pacing at low right atrial (LRA), measure the early activation site, the activation sequence and time of coronary sinus, the activation time between Bachmann boundle(BB) and coronary sinus ostium(CSo), the activation time between LRA and CSo. Results: (1) Ablation at the ostium and proximal of coronary sinus could made entirely or partly blocking of conduction by coronary sinus. Before ablation, CSo activated prior to BB. After ablation, BB activated prior to CSo; (2) Coronary sinus is thepreferential conduction pathway during pacing at LRA. The atrial activation time delayed from 61. 14 +8. 36ms to 88. 4 3+19. 22ms after ablation. Conclusion: It is possible to block the conduction pathway of coronary sinus by ablation in proximal of coronary sinus. PART III The Relationship between the Coronary Sinus Electrogram and the Coronary Sinus Muscular Sleeve PotentialObjective: Investigate into the coronary sinus electricity diagram and its relationship with the CS muscle sleeve electric potential. Prove coronary sinus A wave is not only a pure atrium wave, but the wave fusion of coronary sinus muscle sleeve electric potential with left atrial electric potential, and the prior take a mainly role. Methods: 22 cases of patient with PSVT are involved in the study. After the success of RFCA, under the situation of sinus rhythm, RS2(a late extrastimuli) were issued in the proximal coronary sinus electrode( CS9,10) . The beginning of RS2 equals the period between the electrocardiogram R wave top and the next A wave of electrode CS9,10, then 5 mses is gradually decreased. Observe the coronary sinus A wave morphology,its proper orderand form variety, double electric potential and excited time of coronary sinus ( CSo - CSd). Results: During sinus rhythmthe, the A wave of CS1.2 of 68% patients (15/22) is firstly negative and backward positive direction ,with breadth form and many compositions. When the RS2 is enough early, the A wave of CSi,2 changes into first positive direction backward negative , its form is narrow and composition is pure, mostly the form of QS and a high frequency sharp form, pure and narrow, the concussion is in proper order for near to far, the A wave being apart from each other .The exciting time between CS9.10 and CSi.2s is longer. Firstly ,RS2capture the A wave of the proximal coronary sinus, make it advance in time, and during this time the A wave of distal CS did not advance in time and change i... |
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