摘要 尽管目前对心房颤动（房颤）的机制已经有了深入的了解，但房颤的治疗依然富有挑战性。著名的“主导环理论”对功能性折返进行了详细的定量描述，距今提出已有40余年。随后数十年的研究中，基于螺旋波的房颤驱动理论应运而生。转子是二维平面上的波旋转产生的涡流，可以生成螺旋波。在房颤的实验和临床研究中，通过光学标测方法，可以识别出转子的存在。然而，由于研究方法的限制和转子机制的复杂性，理论研究和临床研究结果难以统一。本文分析总结了数十年来关于转子的产生、电生理特点、三维结构多样性的理论研究，并比较临床上最新的转子标测方法，如全景标测和局部高密度标测。尽管转子的标测和消融有望成为最佳房颤治疗手段，但在全景标测和局部高密度标测方面仍然存在不一致的结果。据此我们提出，临床上转子的识别可能受到下列因素的影响： ① 螺旋波具有三维形式的多样性，因而其二维平面激动特点也各不相同；② 由于标测手段的分辨率不足，可产生转子识别误差。随着理论和技术的快速发展，需要进一步的研究来弥补转子标测技术在临床应用方面的不足，促进基础研究和临床研究之间的转化，以提高转子标测的准确率。
Abstract：Treatment of atrial fibrillation(AF) remains challenging despite a deep understanding of its underlying mechanisms. The detailed and quantitative description of functional reentry, the famous “leading circle” model, was developed more than 40 years ago. Subsequently, an alternative paradigm based on spiral waves has long been postulated to drive AF in decades of study. Rotor as a “spiral wave generator”, is a curved “vortex” formed by spin motion in the twodimensional plane, which can be identified by using advanced mapping methods in experimental and clinical AF. However, it is difficult to achieve complementary results between basic results and clinical studies due to limited research methods and complexity of rotor mechanism. This paper reviews knowledge garnered over decades on generation, electrophysiological properties and threedimensional structure diversity of the rotor, and make a comparison among the latest clinical approaches of rotor identification, such as panoramic mapping and local highdensity mapping. Although the rotor mapping and ablation perform as a promising therapeutic option for AF, some inclusive outcomes of studies remain existing in either panoramic mapping or local high-density mapping. It is proposed that the clinical rotor identification might be substantially influenced by (ⅰ) non-identical surface activation patterns resulted from diverse threedimensional forms of scroll wave, and (ⅱ) inadequate resolution of mapping techniques. With rapidly advancing theoretical and technological developments, future work is required to resolve the clinical limitations in current basic and clinical research methodology, in translation from one to the other, and in resolution of available mapping techniques.
秦牧，刘韬，刘旭. 心房颤动的转子机制与标测[J]. 实用心电学杂志, 2020, 29(5): 348-355.
Qin Mu, Liu Tao, Liu Xu. Rotor mechanism and its mapping in atrial fibrillation. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2020, 29(5): 348-355.
