臺灣博碩士論文加值系統

心房顫動是臨床上最常見的心律不整，同時也是造成心因性中風的主要原因。心房顫動所引起的快速心室跳動，可以產生一系列不良的影響，包括：心臟衰竭和心律過速所引起的心肌收縮力下降。而且心房顫動和心房擴大，在臨床上有很好的相關性。大部分的病人，心房顫動都合併有心房擴大的情形。心房擴大後易於形成心房顫動的機轉是我們想要探討的目標。心房顫動形成的理論主要是有三種--多數波理論(multiple-wavelet hypothesis)，局部來源理論(focal-source hypothesis) 和單一迴旋母波(single reentry circuit with fibrillatory conduction)。尤其是心房顫動的多數波理論，被大部分學者認為是這一類心律不整的主因。然而另一類病患中，心房顫動往往是由心房的一個局部地區快速放電所形成的，其中包括肺靜脈，上腔靜脈或者是Marshall韌帶等。因此，心房擴大之後，心房顫動的機轉是我們研究的重點。本研究將利用狗的動物模式，也就是將狗的心臟給予離體之後，再將其心房擴大，然後經由電刺激來誘發心房顫動並探討其形成的機轉。在第一章中，我們會先回顧心房顫動的流行病學及血流動力的變化。在第二章中，將會探討心房顫動形成的原理，包含多數波理論、局部來源理論和單一迴旋母波理論。多數波理論與波長理論(wavelength)的關係密切。局部來源理論是認為在心房顫動的時候，是由心房的某個地方，有一個所謂的驅動點(driver)，由它來驅動心房顫動的發生，而這些驅動點特別多位在左心房。另外，單一迴旋母波亦可引發心房顫動。第三章中，我們將介紹在心房擴大之後，用高密度波形紀錄技術(high-density mapping technique)來探討心房顫動發生的原因與傳導的不勻稱性(heterogeneity)之間的關聯。第四章中，將用非接觸性氣球導管(non-contact mapping balloon catheter)分別放置於右心房及左心房，來探討心房擴大之後，心房整體性電氣波的變化。以及心房擴大之後，它的最大主要頻率(maximal dominant frequency)與電氣波數目(wavefront number)的關聯性。第五章中，將要研究在心房擴大之後，心房組織內隙連結(gap junction)的變化。包括：連接素(connexin)與心房傳導速度上的關聯。
結論：在離體狗心臟的急性心房擴大研究中，可以發現心房傳導的變化--包括心房擴大之後，心房傳導速度的變慢及傳導不勻稱性的增加。由非接觸性氣球導管分析中，可以發現心房顫動發生時，最大主要頻率是位於左心房的後壁，而且與電氣波分裂(wavefront splitting)有很大的關聯。再加上心房組織連接素的變化，更可以發現到心房擴大之後，心房傳導速度的變慢與病理及分子上的原因。

Atrial fibrillation (AF) is the most commonly encountered sustained arrhythmia and the major factor of cardiogenic stroke. AF could result in a series of adverse effects, such as heart failure, rapid ventricular response and decrease of myocardial contractility. Clinical association of AF with atrial enlargement has led to the assumption that atrial stretch plays an important role in the occurrence of AF. However, it is not clear what the mechanism of AF in acute atrial dilatation is. Multiple wavelets, focal source, and single reentry circuit with fibrillatory conduction are three hypotheses to explain the mechanisms of AF. Which one is the major role and what is the contribution to AF in acute atrial dilatation? Our studies will use isolated Langendorff-perfused canine hearts to investigate the effects of atrial dilatation on the atrial electrophysiological properties by high-density mapping techniques (contact high-density plaque and non-contact mapping systems).
First, we will review the epidemiology, prognosis and the hemo- dynamic consequences of AF in chapter one. In chapter two, we will discuss the three major hypotheses of AF—multiple wavelets, focal-source, and Lewis hypothesis (single reentry circuit with fibrillatory conduction). In chapter three, we will study the changes of atrial conduction characteristics by high-density mapping plaque in acute atrial dilatation. In chapter four, bi-atrial global mapping by non-contact mapping system will show the characteristics of wavefronts in AF during atrial dilatation. We will study the changes of dominant frequency in AF during atrial dilatation. In chapter five, we further investigate the changes of gap junction during atrial dilatation.
There are three major conclusions in this thesis: (1) During atrial dilatation, the increase of dispersion in refractoriness and regional slow conduction are related to the induction of AF. (2) In acute atrial dilatation, the percentage of the low voltage zones increased, especially in the LA posterior wall, which was correlated with the regional splitting of the AF wavefronts. The increase in the splitting facilitated the formation of new wavefronts, and resulted in a higher max dominant frequency during acute atrial dilatation. (3) The reduction of connexin 40, widening of interstitial space, cardiomyocyte swelling, and disconnection of myofibril may work together to reduce the conduction after atrial dilatation.

目錄
中文摘要---------------------------------------------------------2-4
英文摘要---------------------------------------------------------5-6
中英文對照表--------------------------------------------------7-10
第一章 緒論--------------------------------------------------11-15
第二章 心房顫動形成的機轉-----------------------------16-22
第三章 心房擴大之後心房電氣特性的改變-----------23-47
第四章 心房擴大之後心房顫動時主要頻率的變化--48-76
第五章 心房擴大之後隙連結及傳導速度的變化-----77-92
第六章 結論--------------------------------------------------93-96
參考文獻------------------------------------------------------97-113
已發表之論文及相關著作--------------------------------114-115

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