冠状静脉窦和左房电传导特性的研究

Study of the electrical conduction between the left atrium and the musculature of the coronary sinus

目的：通过冠状窦近端和远端起搏，比较阵发性房颤组和对照组冠状窦电图波形的改变、有效不应期的变化，探讨发生房颤的电学特征改变。方法：39例因心律失常行导管射频消融的患者，其中17为阵发性房颤患者，对照组22例。置入10极电生理导管至冠状窦，在X线下使导管的9～10极位于冠状窦口。固定程序S1S2400／360ms起搏冠状窦的近端和远端，2倍的起搏阈值，记录冠状窦电图。测定远端和近端起搏局部的有效不应期。结果：在冠状窦电图上有双电位和碎裂电位房颤组占13／17，对照组占5／22（P〈0．05）。房颤组CS1～2局部有效不应期（ERP）明显较对照组短（P〈0．05）；房颤组CS9-10处ERP和对照组比较无明显差异。结论：在房颤组冠状窦电图记录到双电位和碎裂电位，同时在冠状窦远端起搏时其ERP缩短，这些可能是房颤发生的基质。

Objective： To （ERP） at the local position of CS observe the change of CS electrigram , the effective refractory period pacing in patients with atrial fibrillation and in control subjects during distal and proximal CS pacing. Methods： The study population consisted 39 Patients with arrhythmia underwent radio frequency catheter ablation （RFCA）. These include seventeen patients with PAF and twenty-two control patients. A decapolar catheter with 2-mm interelectrode spacing every 10mm was insert into the CS, with the proximal electrode pair positioned at the ostium. Baseline S1 and one single extrastimulus （S2） were delivered in distal and proximal CS electrode , while recordings were obtained from the other four pair eletrodes. The ERP was measured at drive cycle lengths of 400ms in patients with PAF and in control subjects. Results： Double or fractionated potentials were recorded in 13/17 patients with PAF and 5/22 control subjects with other arrhythmias （ P 〈 0. 05 ）. Patients with PAF had shorter ERP during distal pacing than control subjects. There was no difference of ERP during proximal pacing between patients with PAF and control subjects. Conclusion： Recording of double or fractionated potentials within the CS in patients with PAF was more common than in control subjects. The patients with PAF have longer ERP during distal pacing. These may be the substrate of AF.