特发性房颤患者心房电生理特点的临床观察VIP专享VIP免费

�论著�特发性房颤患者心房电生理特点的临床观察时向民�王玉堂�单兆亮�赵立朝�国建萍�周俊彦(解放军总医院心内科,北京�100853)��[摘要]�目的�分析特发性房颤(idiopathicatrialfibrillation,IAF)患者与正常对照在基础状态及不同联律间期早搏刺激后心房有效不应期(effectiverefractoryperiod,ERP),不应期离散度(ERPdispersion,ER-PD)的差别,探讨IAF的发病机制。�方法�2005年4~7月住院的21例无器质性心脏病室上性心动过速患者,其中6例伴有阵发性房颤。所有患者室上速射频消融成功后,程控刺激高右房(highrightatrium,HRA),冠状窦远端(coronarysinusdistal,CSD),测出上述两个部位基础刺激时(S1S1500ms)心房ERP。保持基础刺激不变,分别给予不同联律间期的S2早搏刺激(S1S1不应期+20ms,+70ms,+120ms,+170ms),通过发放S3测出不同S2早搏刺激后心房ERP。以基础及早搏刺激后HRA与CSD不应期的差值作为ERPD。�结果�6例IAF患者在HRA予S2早搏刺激(S1S1不应期+20ms)时诱发房颤,HRA的ERP在基础及各种联律早搏刺激时明显短于对照组(P<0.05),CSD刺激时ERP两组无差别(P>0.05),IAF组ERPD较对照明显增大(P<0.05)。(S1S1不应期+20ms)的S2刺激较其他S2刺激使心房ERP缩短最为明显(P<0.05)。�结论�HRA短ERP,增大的ERPD是IAF患者发病的电生理基础。短联律间期早搏刺激使ERP缩短更为明显,是房颤发作的始动因素。��[关键词]�心房颤动;电生理学ClinicalObservationonAtrialElectrophysiologicalCharacteristicsinPatientswithIdiopathicAtrialFibrillation���SHIXiang-Min,�WANGYu-Tang,�SHANZhao-Liang,etal(DepartmentofCardiology,TheGeneralHospitalofPLA,Beijing100853,China)��[Abstract]�Objective�Toinvestigatetheelectrophysiologicalmechanismofidiopathicatrialfibrillation(IAF)byanalyzingthedifferenceofeffectiverefractoryperiod(ERP)andERPdispersionbetweenpatientswithIAFandnormalcontrol.�Methods�Twenty-onepatientswithparoxysmalsupraventriculartachycardiawithoutstructuralheartdiseaseunderwentradiofrequencyablationbetweenApr.2005andJul.2005werestud-ied,ofwhom6patientshaddocumentedparoxymalIAF.Aftertheprocedureofablation,allpatientsunder-wentprogrammedstimulationatthesitesofhighrightatrium(HRA)andthedistalportionofcoronarysinus(CSD)untiltheatrialERPofS1wasreached,thenS1(500ms),S2(atrialERPofS1+20ms,+70ms,+120ms,+170ms),S3stimulationwasdeliveredtopatientsuntiltheatrialERPofdifferentS2wasreached.�Results�Atrialfibrillationwasinducedin6patientswithIAFbyS2(atrialERPofS1+20ms)stimulationfromHRA.ERPofHRAunderbasicandS2stimulationinpatientswithIAFwassignificantlyshorterthanthatofnormalcontrol(P<0.05),therewasnodifferenceaboutERPofCSDbetweenthetwogroups(P>0.05).S2(atrialERPofS1+20ms)stimulationmoresignificantlyshortenedtheatrialERPcomparedwiththatofthelongerS2(P<0.05).�Conclusion�ShortERPofHRAandincreasedERPdispersionareelectrophysio-logicalsubstrateofIAF,shortercouplingintervalofprematureatrialcontractionplaysanimportantroleintheinitiationofatrialfibrillation.��[Keywords]�atrialfibrillation;electrophysiology[中图分类号]�R541.75�[文献标识码]�A�[文章编号]�1671-7171(2006)10-1601-04��心房纤颤多发于器质性心脏病患者,也见于不伴基础心脏病者,称之为孤立性房颤或特发性房颤(IAF)。虽然超声心动图,X线胸片等检查未见心脏解剖及运动异常,但患者可能存在电生理异常,本研究旨在探讨IAF患者心房电生理特点,寻找其发病的电生理机制。�1601�医学临床研究�2006年10月�第23卷�第10期�JClinRes,Oct.2006,Vol23,�101�资料与方法1.1�临床资料�2005年4月至2005年7月在本院行电生理检查及射频消融治疗的21例室上性心动过速患者。其中男性13例,女性8例,年龄41.5(15~60)岁。有阵发性心动过速病史2~10年,有心电图证实的阵发性室上性心动过速。其中房...