阵发性心房颤动患者心房复极离散度的研究(摘要)
作者：李真 袁世文 杨延宗 林治湖 Eva Hertervig(第二作者)
单位：辽宁省大连市，大连医科大学附属第一医院 心内科(116011) 李 真 袁世文 杨延宗 林治湖；瑞典LVND大学医学院 心脏科 Eva Hertervig(第二作者)
关键词：
目的 目的：通过记录阵发性心房颤动(房颤)患者右心房单相动作电位(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组与无房颤病史的对照组患者各15例，均接受心内电生理检查(EPS)和(或)射频导管消融术(RFCA)治疗。两根MAP电极在右心房共取4～10个不同部位，进行同步的窦性心律(SR)、S1及S2时的MAP记录，测量、计算心房复极离散度(RT-disp)及其两个组成成份——动作电位时程和局部激动时间的离散度(APD-diff、AT-diff)。
, 百拇医药
结果：窦性心律时房颤组Max-RT-disp显著大于对照组(123.69±54.67 ms比64.25±23.29 ms,P<0.01)。其差异主要来源于APD-diff(115.00±46.90 ms比57.56±33.57 ms,P<0.01),AT-diff差异无显著性。随S1、S2的加入，AT及AT-diff逐渐增大，Max-APD逐渐缩短，且房颤组的改变程度显著大于对照组。S1刺激时无房颤发生，加入S2刺激时，大多数房颤患者多次诱发出短阵房颤(15例中10例诱发出20次短阵房颤)，诱发率及次数均显著高于对照组(15例中4例诱发出6次短阵房颤)。
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。S2刺激时心房应激性增高、传导速度减慢，易于折返、房颤的发生。此变化在阵发性房颤患者中更为显著，因而房颤更容易诱发出来。房颤组心房Max-RT-disp在窦性心律时显著高于对照组，其差异主要来源于APD-diff的增加，AT-diff无显著性差异，提示心房复极离散度的增加是阵发性房颤发生的重要基础因素。
, 百拇医药
Dispersion of Atrial Repolarisation in Patients with Paroxysmal Atrial Fibrillation (Abstract)
Department of Cardiology, The First Affiliated Hospital, Dalian Medical University, Dalian (116011), Liaoning
Li Zhen, Eva Hertervig (Sweden), Yuan Shiwen, et al.
Objective: To study the correlation between the dispersion of atrial repolarisation (DAR) and the development of atrial fibrillation (AF).
, 百拇医药
Methods: Monophasic action potentials (MAPs) were simultaneously recorded with two catheters in the right atrium (RA) in patients with paroxysmal atrial fibrillation (AF) and in control group without AF. Fifteen patients with idiopathic paroxysmal AF (AF group), and 15 patients with paroxysmal supravetricular tachycardia but no history of AF (control group) entered the study. MAPs were recorded with a catheter at the high lateral right atrium (HLRA) and a catheter moving around the high, middle and low lateral regions, septal regions and the appendage in the RA (totally 4 to 10 sites) in each patient. After recording during sinus rhythm (SR), the MAPs were recorded during regular pacing (S1) at a drive cycle of 500 ms, and during an extra-stimulus (S2) at 10～20 ms higher than the effective refractory period (ERP) via the HLRA catheter. Taking the MAPs at the HLRA as reference, the dispersion of repolarisation time (RT-disp) and its two components, the dispersion of local activation time (AT-diff) and that of the action potential duration (APD-diff) were calculated.
, 百拇医药
Results: Maximal RT-disp among the 4 to 10 sites in the AF group (123.69±54.67 ms) during sinus rhythm was significantly greater than that in the control group (64.25±23.29 ms), p<0.01. The increased RT-disp in the former group was mainly due to the increase of the APD-diff (115.00±46.90 ms and 57.56±33.57 ms in the AF and control group, respectively, p<0.01), while the AT-diff gave almost no contribution. In each group, with the adding of S1 and S2 stimulation, the APD was shortened, indicating shortening of the refractory period, while the AT and AT-diff were significantly increased, showing greatly slowed local conduction by stimulations. And these changes were greater in the AF group than in the control group. During S1 no episode of paroxysmal AF was induced. While during S2, 20 paroxysms were induced in 10 patients of the AF group, much higher than that of the control group (6 paroxysms in 4 cases).
, 百拇医药
Conclusion: The DAR during sinus rhythm is greater in patients with paroxysmal AF due to the increase in APD difference, which suggests that the disturbance of atrial repolarisation is an important fundamental factor in the development of paroxysmal AF. Extrastimulation not only shortens the APD but also increase the local conduction time of atrium, and these changes are greater in the AF group. During S2 stimulation, both the APD difference and the disturbed local conduction contribute to the induction of paroxysmal AF., 百拇医药
单位：辽宁省大连市，大连医科大学附属第一医院 心内科(116011) 李 真 袁世文 杨延宗 林治湖；瑞典LVND大学医学院 心脏科 Eva Hertervig(第二作者)
关键词：
目的 目的：通过记录阵发性心房颤动(房颤)患者右心房单相动作电位(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组与无房颤病史的对照组患者各15例，均接受心内电生理检查(EPS)和(或)射频导管消融术(RFCA)治疗。两根MAP电极在右心房共取4～10个不同部位，进行同步的窦性心律(SR)、S1及S2时的MAP记录，测量、计算心房复极离散度(RT-disp)及其两个组成成份——动作电位时程和局部激动时间的离散度(APD-diff、AT-diff)。
, 百拇医药
结果：窦性心律时房颤组Max-RT-disp显著大于对照组(123.69±54.67 ms比64.25±23.29 ms,P<0.01)。其差异主要来源于APD-diff(115.00±46.90 ms比57.56±33.57 ms,P<0.01),AT-diff差异无显著性。随S1、S2的加入，AT及AT-diff逐渐增大，Max-APD逐渐缩短，且房颤组的改变程度显著大于对照组。S1刺激时无房颤发生，加入S2刺激时，大多数房颤患者多次诱发出短阵房颤(15例中10例诱发出20次短阵房颤)，诱发率及次数均显著高于对照组(15例中4例诱发出6次短阵房颤)。
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。S2刺激时心房应激性增高、传导速度减慢，易于折返、房颤的发生。此变化在阵发性房颤患者中更为显著，因而房颤更容易诱发出来。房颤组心房Max-RT-disp在窦性心律时显著高于对照组，其差异主要来源于APD-diff的增加，AT-diff无显著性差异，提示心房复极离散度的增加是阵发性房颤发生的重要基础因素。
, 百拇医药
Dispersion of Atrial Repolarisation in Patients with Paroxysmal Atrial Fibrillation (Abstract)
Department of Cardiology, The First Affiliated Hospital, Dalian Medical University, Dalian (116011), Liaoning
Li Zhen, Eva Hertervig (Sweden), Yuan Shiwen, et al.
Objective: To study the correlation between the dispersion of atrial repolarisation (DAR) and the development of atrial fibrillation (AF).
, 百拇医药
Methods: Monophasic action potentials (MAPs) were simultaneously recorded with two catheters in the right atrium (RA) in patients with paroxysmal atrial fibrillation (AF) and in control group without AF. Fifteen patients with idiopathic paroxysmal AF (AF group), and 15 patients with paroxysmal supravetricular tachycardia but no history of AF (control group) entered the study. MAPs were recorded with a catheter at the high lateral right atrium (HLRA) and a catheter moving around the high, middle and low lateral regions, septal regions and the appendage in the RA (totally 4 to 10 sites) in each patient. After recording during sinus rhythm (SR), the MAPs were recorded during regular pacing (S1) at a drive cycle of 500 ms, and during an extra-stimulus (S2) at 10～20 ms higher than the effective refractory period (ERP) via the HLRA catheter. Taking the MAPs at the HLRA as reference, the dispersion of repolarisation time (RT-disp) and its two components, the dispersion of local activation time (AT-diff) and that of the action potential duration (APD-diff) were calculated.
, 百拇医药
Results: Maximal RT-disp among the 4 to 10 sites in the AF group (123.69±54.67 ms) during sinus rhythm was significantly greater than that in the control group (64.25±23.29 ms), p<0.01. The increased RT-disp in the former group was mainly due to the increase of the APD-diff (115.00±46.90 ms and 57.56±33.57 ms in the AF and control group, respectively, p<0.01), while the AT-diff gave almost no contribution. In each group, with the adding of S1 and S2 stimulation, the APD was shortened, indicating shortening of the refractory period, while the AT and AT-diff were significantly increased, showing greatly slowed local conduction by stimulations. And these changes were greater in the AF group than in the control group. During S1 no episode of paroxysmal AF was induced. While during S2, 20 paroxysms were induced in 10 patients of the AF group, much higher than that of the control group (6 paroxysms in 4 cases).
, 百拇医药
Conclusion: The DAR during sinus rhythm is greater in patients with paroxysmal AF due to the increase in APD difference, which suggests that the disturbance of atrial repolarisation is an important fundamental factor in the development of paroxysmal AF. Extrastimulation not only shortens the APD but also increase the local conduction time of atrium, and these changes are greater in the AF group. During S2 stimulation, both the APD difference and the disturbed local conduction contribute to the induction of paroxysmal AF., 百拇医药