风湿性心脏病并心房颤动患者心房及肺静脉的心脏电生理特点

Electrophysiological study of atrium and pulmonary veins in atrial fibrillation patients with rheumactic heart disease

目的 :测定风湿性心脏病并心房颤动 (Af)患者心房及肺静脉的有效不应期 (ERP) ,探讨其电生理特点。方法 :6例持续性Af患者术前 2～ 3周予抗凝治疗 ,术前 7d予胺碘酮转复 ,1例转复成功 ,另 5例经同步直流电转复治疗 ;3例阵发性Af患者术前未予以抗凝和药物转复治疗。 9例患者均行二尖瓣球囊扩张术 ,术后行电生理检查 ,标测肺静脉尖峰电位并测定左、右心房及肺静脉ERP。结果 :9例患者均可在肺静脉内标测到肺静脉电位。 9例患者的右房、左房、左上肺静脉平均ERP分别为 (2 12 .2 2± 30 .73)ms、(2 5 7.78± 33.4 6 )ms、(2 5 2 .2 2±4 2 .36 )ms ;5个左下肺静脉ERP(2 4 0 .0 0± 5 3.39)ms;平均肺静脉ERP(2 4 2 .5 0± 4 8.6 2 )ms。右房ERP比左房的短 ,右房ERP比左上肺静脉的短 (P值分别为P <0 .0 1、P <0 .0 5 )。 12个Af起源点的ERP为 (2 15 .0 0± 5 3.70 )ms,而 2 4个非Af起源点的ERP为 (2 4 8.33± 35 .77)ms,Af起源点的ERP较短 (P <0 .0 5 )。结论 :风湿性心脏病患者肺静脉内可以记录到肺静脉电位 。

Objection:To study the electrophysiology by measuring the effective refractory period (ERP) from atria and pulmonary veins in atrial fibrillation(AF) patients with rheumatic heart disease. Method:Six patients with persistent Af received anticoagulation therapy (warfarin 2 or 3 weeks) and drug cardioversion (amiodarone 400 mg, three times per day, for 7 days ) before procedures, while other 3 patients with paroxysmal Af received neither anticoagulation therapy nor drug cardioversion. All patients received percutaneous balloon mitral valvotomy (PBMV). After finished PBMV, four multipolar electrode catheters were placed in the high right atrium (HRA), coronary sinus (CS), left atrium (LA) and pulmonary veins (PVs). Mapped the potentials of PVs and measured the ERP of HRA, CS, LA, and PVs. Result:PVs potentials could be recorded in all 9 patients. The ERP of HRA, LA and left superior pulmonary vein were measured in 9 patients, they were ( 212.22± 30.73)ms, ( 257.78± 33.46)ms and ( 252.22± 42.36)ms respectively. The ERP of left inferior pulmonary vein was ( 240.00± 53.39)ms in 5 cases. All 16 pulmonary veins had an averaged ERP of ( 242.50± 48.62)ms. 12 Af original sites had an average ERP with ( 215.00± 53.70)ms, which was significant shorter than that of the else sites where Af could not be induced (P< 0.05). Conclusion:PVs potentials could be recorded in rheumatic heart disease patients. ERP of Af original sites is shorter than that of other sites.