摘要
目的 探讨快速心房激动对心房电生理特性的影响。方法 以 15 0～ 2 0 0ms起搏周长(PCL)对 2 1例射频消融术后患者右心房进行S1S1刺激诱发心房颤动 ,心房快速刺激前、后均以 40 0ms周长分别对高位右心房 (HRA)、低位右心房 (LRA)、希氏束周围 (HB)、右心耳 (RAA)等多部位进行S1S2 扫描 ,测定心房有效不应期 (ERP)、有效不应期空间离散度 (ERPd)、右心房内及心房间传导时间(CT)的变化 ;以 35 0ms、 40 0ms和 45 0ms 3个不同周长随机对RAA进行S1S2 扫描 ,观察有效不应期频率自适应性 (ERPA)的变化。结果 快速心房激动后ERP较刺激前有明显缩短 ,HRA的ERP [(193 2±2 5 5 )msvs(179 7± 2 3 3)ms ,P =0 0 0 1]、LRA的ERP [(198 0± 30 8)msvs(182 0± 2 2 5 )ms ,P =0 0 2 6 ]、HB的ERP [(195 0± 2 6 6 )msvs(182 0± 16 8)ms,P =0 0 18]、RAA的ERP [(194 0± 2 0 1)msvs(180 0± 2 9 0 )ms,P =0 0 14]。而ERPd则无明显变化 [(2 5 0± 17 8)msvs(2 8 0± 16 9)ms,P =0 5 76 ];3个不同周长下RAA的ERP均较心房快速激动前有显著缩短 ,S1S1为 35 0ms、 40 0ms和 45 0ms,心房快速激动前后ERP分别为 [(186 2± 2 4 4 )msvs(16 8 7± 30 9)ms,P =0 0 0 6 ]、[(194 0± 2 0 1)msvs(180
Objective The aim of this study is to investigate the effects of rapid pacing on atrial electrophysiological characteristics.Methods Acute atrial fibrillation was induced by rapid atrial pacing(S 1S 1)with a cycle length of 150 to 200 ms in 21 patients after successful radio frequency catheter ablation(RFCA).The effective refractory period(ERP),ERP dispersion and the inter-atrium/intra-atrium conduction time were measured with S 1S 2 scan(drive cycle length 400 ms)before and after rapid atrial pacing in multiple sites including high right atrium(HRA),low right atrium(LRA),HIS bundle area(HB)and right atrial appendage(RAA).To determine the ERP rate adaptating feature,ERPs were measured in RAA at 3 pacing cycle lengths(350,400,450 ms)respectively.Results As compared to parameters before rapid atrial pacing,atrial ERP shortened significantly in HRA[(193.2±25.5) ms vs(179.7±23.3) ms,[WTBX]P=0.001],LRA[(198.0±30.8) ms vs(182.0±22.5) ms,[WTBX]P=0.026],HB[(195.0±26.6) ms vs(182.0±16.8) ms,[WTBX]P=0.018] and RAA[(194.0±20.1) ms vs(180.0±29.0) ms,[WTBX]P=0.014] after rapid atrial pacing.Atrial ERPd after rapid pacing had no significant difference from that before rapid pacing[(25.0±17.8) ms vs(28.0±16.9) ms,[WTBX]P=0.576].ERPs of RAA also shortened after rapid pacing at various drive cycle length of{350 ms[(186.2±24.4) ms vs(168.7±30.9) ms,[WTBX]P=0.006],400 ms,400 ms[(194.0±20.1) ms vs(180.0±29.0) ms,[WTBX]P=0.014]and 450 msand 450 ms[(191.2±33.1) ms vs(170.0±28.3) ms,[WTBX]P=0.0001]}}.There is a strong correlation between ERPs and the pacing rates(r b=0.998,P=0.041)before rapid pacing,but there is no relationship between ERPs and pacing rates after rapid pacing(r a=0.397,P=0.74).The slope was almost normal(0.058)before rapid pacing,and lower(0.015) after rapid pacing.There is no significant difference in conduction time inter-atrium and intra-atrium,with a value of HRA-HB[(46.5±12.5) ms vs(48.4±12.0) ms,[WTBX]P=0.125]and HB-CSD[(47.0±14.2) ms vs(49.6±14.8) ms,[WTBX]P=0.153].Conclusion ERPs shorten obviously at different pacing cycle lengths and in different atrial sites,and atrial ERP adaptation to rates is poor after rapid pacing.But ERPd and conduction time inter-and intra-atrium remain unchanged after rapid pacing.These indicate atrial rapid pacing induces atrial electrophysiological remodeling,which plays an important role in developing,sustaining as well as progressing of atrial fibrillation.
出处
《中华心律失常学杂志》
2001年第5期296-299,共4页
Chinese Journal of Cardiac Arrhythmias
关键词
心动过速
电生理
心房颤动
Tachycardia
Electrophysiology
Atrial fibrillation
