风湿性心脏病心外膜标测心房电位的对比研究

Comparison of Atrial Potential by intraoperative Epicardial Mapping

采用术中心外膜标测方法 ,对风湿性心脏病 (简称风心病 )慢性心房颤动 (简称房颤 )及其电复律后窦性心律、风心病窦性心律及非风心病窦性心律的心房电位进行比较研究。选择风心病慢性房颤患者 18例 (Ⅰ组 )、风心病窦性心律患者 9例 (Ⅱ组 )、非风心病窦性心律患者 8例 (Ⅲ组 ) ,采用 18导同步心外膜标测 ,通过心外膜电图对房波电位顺序进行分析 ,并对三组患者的心房有效不应期 (ERP)进行比较。结果 :窦性心律患者 (Ⅱ组与Ⅲ组 )以右房侧壁上部房波电位最为领先 ,慢性房颤患者 (Ⅰ组 )左房房波多以后下部最为领先 ;Ⅰ组心房ERP最短 ,Ⅱ组次之 ,Ⅲ组最长 ,以左房后壁中部、中下部、下部相差最为明显 (P <0 .0 1) ,而心房其它部位亦有显著差异 ,P <0 .0 5 ;Ⅰ组左房与右房ERP比较 ,左房中、中下及下部ERP均明显短于右房相应部位的ERP(P <0 .0 5 ) ;Ⅰ组中左房传导时间均明显长于Ⅱ组与Ⅲ组 (P <0 .0 1)。结论 :风心病慢性房颤患者的房波电位多起源于左房 ,其左房传导时间明显长于窦性心律患者 ,而心房ERP明显短于窦性心律患者。

To compare the differences among atrial potential of atrial fibrillation and sinus rhythm after defibrillation with rheumatic heart disease(RHD), sinus rhythm with RHD, sinus rhythm with non-RHD. Thirty-five patients were divided into three group: group Ⅰ(n=18) atrial fibrillation with RHD, group Ⅱ(n=9) sinus rhythm with RHD, group Ⅲ(n=8) sinus rhythm with non-RHD. intraoperative epicardial maps were acquired by 18-lead mapping and sequences of atrial potential were analyzed and atrial effective refractory periods(AERP) were compared. Results: The earliest part of atrial potential located in upper-lateral wall of right atrium in sinus rhythm group(group Ⅱ and Ⅲ),whereas in atrial fibrillation group(group Ⅰ) the earliest part of atrial potential in left atrium located in lower-posterior wall of left atrium. AERP in group Ⅰ was shortest, a little longer in group Ⅱ,and it was longest in group Ⅲ, P<0.01 in middle,middle-lower and lower poterior left atrium left atrium and P<0.05 in other atrium. AERP of lower-poterior left atrium in group Ⅰ was shorter than that correspondent area in right atrium, P<0.05. Conduction time of left atrium in group Ⅰ was significant longer that in group Ⅱ and group Ⅲ, P<0.01. Conclusions: Most of atrial potential of atrial fibrillation in RHD patients originated from left atrium, and its left atrial conduction time is significant longer than sinus rhythm ones whereas AERP is significant shorter than sinus rhythm ones.