风湿性心脏病慢性心房颤动心肌波长指数与有效不应期的电生理特征

Electrophysiologic characteristics of atrial wavelength indices and effective refractory period of chronic atrial fibrillation in rheumatic heart disease

目的 运用波长指数 (WLI)和心房有效不应期 (AERP)等指标对风心病慢性心房颤动(房颤 )心外膜标测电图进行分析 ,以揭示其相关的电生理特征。方法 风心病慢性房颤组 4 3例 ,采用左右房 16导同步心外膜标测房颤的各部位AERP和WLI。计算公式WLI=平均ff间期平均f宽 。无房性心律失常的 10例正常人作为对照组 ,采用心内电生理检查法测定各部位AERP和WLI。计算公式WLI=AERPA2。结果 ( 1)房颤组左房和右房各部位AERP都明显小于对照组 ,P <0 0 5。 ( 2 )房颤组右心耳、右房上、右房中及左房下部WLI均明显小于对照组 ,P <0 0 5。 ( 3 )房颤组右心耳AERP显著长于右房上部 ,为 ( 14 7 2 3± 4 0 92 )ms与 ( 12 7 2 8± 4 4 5 5 )ms,P <0 0 5 ;左心耳AERP显著长于左房上部、中部和下部 ,P值均 <0 0 5。 ( 4 )房颤组右心耳和右房上部WLI显著长于右房中部 ,P值均 <0 0 1;左心耳WLI显著长于左房中部和下部 ,P <0 0 5。 ( 5 )房颤组左心耳WLI显著长于右心耳 ,左房中部WLI显著长于右房中部 ,P值均 <0 0 5。 ( 6)房颤组心房各部位的AERP与WLI进行相关分析 ,右房下部、左心耳、左房中部存在弱相关。结论 4 3例风湿性二尖瓣病心外膜标测的结果提示 。

Objective Epicardial electrogram including atrial wavelength indices (WLI) and atrial effective refractory period (AERP) of atrial fibrillation (AF) in rheumatic heart disease was analysed in order to demonstrate the correlative electrophysiologic characteristics Method Forty three patients with chronic AF in rheumatic heart disease underwent 16 channel epicardial mapping perioperatively, AERP and WLI were measured WLI was calculated according to the following formula: WLI=mean ff interval/mean f width Ten patients without atrial arrhythmias tested electrophysiologically served as controls, and WLI was calculated by the following formula: WLI=AERP/A 2 Results (1) AERP of both atrial were significantly shorter in the AF group compared with the control group, P <0 05 (2) WLI at right atrial appendage, high and medium right atrial wall and lower left atrial wall were significangly smaller in the AF group compared with the control group, P <0 05 (3) AERP at right atrial appendage in the AF group was significantly longer than that at high right atrium (147 23±40 92 ms vs 127 28±44 55 ms, P < 0 05 ); AERP at left atrial appendage was significantly longer than that at medium and lower left atrial wall, P < 0 05 (4) WLI at right atrial appendage and upper right atrial wall were longer than that at the middle section in the AF group, P < 0 01 ; WLI at left atrial appendage was longer than at middle and lower left atrium, P <0 05 (5) WLI at left artial appendage was longer than that at right atrial appendage WLI at middle left atrium in the AF group was significantly longer than at the middle of right atrium, P <0 05; (6) AERP and WLI at lower right atrial and left atrial appendage as well as middle left artium in the AF group showed weak correlation Conclusion The results suggest that shorter AERP and faster conduction at middle posterior wall of the left atrium may be the location of reentry of the leading cycle The secondary persistent reentrant cycle at left atrial appendage and lower right atrial wall may be associated with advanced conduction at the middle left atrium A general tendency of shorter AERP and dispersion of the refractory period as well as functional block was the electrophysiologic basis of multiple reentrant wavelets