阵发性心房颤动患者左右心房电传导特点的临床研究

Clinical Study of the Characteristics of Electrical Conduction Between Left and Right Atriums in Patients With Paroxysmal Atrial Fibrillation

目的探讨阵发性心房颤动患者左右心房电传导的特点。方法选取2012年4月—2013年5月广西医科大学第一附属医院住院行射频消融术的阵发性心房颤动患者19例为心房颤动组,另选取同时期住院的阵发性室上性心动过速或室性期前收缩患者23例为对照组,应用固定程序SIS,500、400、350、300、280 ms分别起搏高位右心房、低位右心房,分别测量冠状窦近端、远端不应期,高位、低位右心房到冠状窦近端、远端传导时间。结果对照组与心房颤动组冠状窦近端、远端不应期比较,差异均无统计学意义(P>0.05)。对照组与心房颤动组不同起搏时间高位右心房到冠状窦近端传导时间比较,差异均无统计学意义(P>0.05);对照组与心房颤动组起搏时间500、400、350 ms时高位右心房到冠状窦远端传导时间比较,差异均无统计学意义(P>0.05);心房颤动组起搏时间300、280ms时高位右心房到冠状窦远端传导时间较对照组延长(P<0.05)。心房颤动组起搏时间500、400 ms时低位右心房到冠状窦近端、远端传导时间较对照组延长(P<0.05);对照组与心房颤动组起搏时间350、300、280 ms时低位右心房到冠状窦近端、远端传导时间比较,差异均无统计学意义(P>0.05)。结论阵发性心房颤动患者冠状窦组织和冠状窦心房交界处存在传导延缓,可能参与心房颤动的促发及维持。

Objective To study the characteristics of electrical conduction between left and right heart atriums in patients with paroxysmal atrial fibrillation （ PAF） .Methods Enrolled 19 PAF patients who received pulsed radiofrequency treatment into the First Affiliated Hospital of Guangxi Medical University from April 2012 to May 2013 as AF group.And another 23 patients with paroxysmal supraventricular tachycardia or ventricular premature contraction were enrolled as control group .A fixed program of SIS was applied.At 500, 400, 350, 300 and 280 ms, pace-making was made in high right atrium （HRA） and low right atrium （ LRA） , and we measured the refractory period in the proximal end and the distal end of coronary sinus and the conduction time from HRA and LRA to the proximal end and the distal end of coronary sinus .Results Control group and AF group were not significantly different （ P 〉0.05 ） in the refractory period in the proximal end and distal end of coronary sinus.Control group and AF group were not significantly different （ P〉0.05 ） in the conduction time from HRA to the proximal end of coronary sinus at different time points of pace -making; control group and AF group were not significantly different （ P〉0.05） in the conduction time from HRA to the distal end of coronary sinus at 500, 400, 350 ms of pace-making; the AF group was higher （P〈0.05） than control group in the conduction time from HRA to the distal end of coronary sinus at 300 and 280 ms of pacemaking.AF group was higher （ P〈0.05） than the control group in the conduction time from LRA to the proximal end and the distal end of coronary sinus at 500 and 400 ms of pacemaking; the control group and the AF group were not significantly different （P〉0.05） in the conduction time from LRA to the proximal end and the distal end of coronary sinus .Conclusion Conduction delay exists in the coronary sinus and the junction of coronary sinus and heart atrium , which may be involved in the onset and sustaining of atrial fibrillation .