摘要
为研究地尔硫卓对快速心房起搏诱发的心房肌急性电重构的影响 ,将 4 0例无器质性心脏病的室上性心动过速患者射频消融成功后 30min随机分为两组 ,地尔硫卓组 15例 ,对照组 2 5例 ;地尔硫卓组给予药物干预 ,对照组以生理盐水替代 ,应用双极记录及单相动作电位记录法检测基础状态下、药物负荷量后 (即快速心房起搏前 )及4 0 0ms周长心房起搏后右心耳、高位右房、低位右房和His束周围等部位有效不应期 (ERP)和右房单相动作电位复极 90 %的时程 (MAPD90 )。结果 :对照组快速心房起搏后心房各部位ERP和右房MAPD90 较刺激前有明显缩短 ,地尔硫卓组心房快速起搏前后各部位ERP和右房MAPD90 无明显改变。结论 :快速心房起搏可使无器质性心脏病和心房颤动病史的患者心房ERP和MAPD90 明显缩短 ,地尔硫卓可阻止快速心房起搏诱发的心房ERP和MAPD90 的缩短 ,提示细胞内钙超载可能是心房ERP和单相动作电位重构的重要原因之一。
To assess the effect of diltiazem on acute atrial electrical remodeling induced by tachycardia through atrial effective refractory period ( ERP) and right atrial monophasic action potential duration(MAPD), forty patients without structural heart disease suffering from paroxysmal supraventricular tachycardia were studied after successful radiofrequency catheter ablation (RFCA), all patients were randomized to two groups (control group and diltiazem group). The quadrupolar electrode catheters were positioned in the high right atrium (HRA), the coronary sinus (CS) and the His bundle area after RFCA. An electrode monophasic action potiential (MAP) catheter was placed in the right atrial free wall. Intravenous atropin (0.04 mg/kg) and propranolol (0.2 mg/kg) were adminstrated in all subjects to prevent the sympathetic nerve activity before the study. The atrial ERP in HRA,LRA,RAA and His with a drive cylce length of 400ms and MAPD_ 90 in the right atrial free wall at sinus rhythm were measured in baseline(after autonomic blockade), before(post-drug or saline) and after rapid atrial depolarization in all subjects. Results: Post-tachycardia atrial ERP in each stimulating site of right atrium and MAPD_ 90 measured in the right atrial free wall shortened significantly in control group. however, both of which remained unchangeable in diltiazem group. Conclusion: Short episodes of rapid atrial pacing may induce atrial electrical remodeling including shortening of atrial ERP and right atrial MAPD_ 90 . Diltiazem could markedly attenuate this effect.
出处
《中国心脏起搏与心电生理杂志》
2003年第6期425-427,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
