阵发性心房颤动患者心房复极离散度的研究

Dispersion of atrial repolarisation in patients with paroxysmal atrial fibrillation

目的 通过记录阵发性心房颤动 (房颤 )患者心房单相动作电位 (MAP) ,分析心房复极离散度与房颤发生的关系。方法 特发性阵发性房颤患者与无自发房颤病史的阵发性室上性心动过速患者各 1 5例 ,均接受心内电生理检查和 /或导管射频消融治疗。两根 MAP电极于右心房共取 4～ 1 0个不同部位进行同步的窦性心律基础刺激 (S1)及期前刺激 S2 时的 MAP记录。测量、计算心房复极离散度(RTd)及动作电位时限和局部冲动时间的离散度 (APDd、ATd)。 结果 窦性心律时房颤组最大 RTd显著大于对照组 (1 2 3 .69± 54.67) ms比 (64 .2 5± 2 3 .2 9) ms,(P<0 .0 1 )。其差异主要来源于 APDd(1 1 5.0 0± 4 6.90 ) ms比 (57.56± 3 3 .57) ms,(P<0 .0 1 ) ,ATd差异无显著性。随 S1、S2 的加入 ,各组局部激动时间和离散度逐渐增大 ,而动作电位时限逐渐缩短 ,且房颤组的这种改变程度显著大于对照组。在S1时无房颤发生 ,加入期前刺激时 ,大多数房颤组患者均多次诱发出短阵房颤。其诱发率及次数均显著高于对照组。 结论 研究结果表明 ,MAP记录技术是临床观察、分析心房复极离散度及其在阵发性房颤中的作用的较佳方法。心房复极离散度的增加是阵发性房颤发生的重要因素。

Objective To study the correlation between the dispersion of atrial repolarisation(DAR) and the susceptibility of AF. Methods Fifteen patients with idiopathic paroxysmal atrial fibrillation (AF group) and 15 patients with paroxysmal supraventricular tachycardia but without history of AF (control group) entered study.Monophasic action potentials MAPs were simultaneously recorded with two catheters in 4 10 sites of right atrium in each patient during sinus rhythm,regular pacing(S1) and an extra stimulus(S2).The DAR and the dispersion of local activation time (AT diff) and that of the action potential duration (APD diff) were measured and calculated. Results The maximal DAR in AF group(123 69±54 67 ms) during sinus rhythm was significantly greater than that in control group (64 25±23 29 ms), P <0 01,mainly due to the increase of the APD diff.In each group,with the adding of S1 and S2 stimulation,the APD was shortened,the AT and AT diff increased.These changes were greater in AF group.During extra stimulus much more paroxysms of AF were induced in AF group.Conclusion The dispersion of atrial repolarisation was an important fundamental factor in the development of paroxysmal AF.During extra stimulation both the shortened APD and the disturbed local conduction contributed to the induction of paroxysmal AF.