Krol R B, Saksena S, Prakash A, Giorgberidze I, Mathew P
Arrhythmia and Pacemaker Service, Eastern Heart Institute, Passaic, New Jersey, USA.
J Interv Card Electrophysiol. 1999 Mar;3(1):19-25. doi: 10.1023/a:1009863220699.
We sought to define a minimum standardized protocol for induction of atrial fibrillation [AF] and/or atrial flutter. In contrast to ventricular stimulation protocols, a stimulation protocol for induction of AF or atrial flutter has not been critically evaluated. Since suppression of inducible AF or atrial flutter is used as one of the endpoints of success of pharmacologic and ablation therapies, there is an obvious need to define a minimally appropriate electrical stimulation protocol for induction of AF or atrial flutter. We prospectively evaluated 70 patients, 44 with spontaneous atrial flutter or AF and 26 controls without documented atrial arrhythmias. A standardized programmed stimulation protocol, which employed up to three atrial extrastimuli delivered at two atrial sites at two atrial drive pacing lengths, was used in attempt to reproduce sustained AF and atrial flutter. The study endpoint was induction of sustained (> 30 s) AF or atrial flutter. Sustained AF or atrial flutter was induced in 39/44 (89%) patients and 2/26 (7%) of controls (p < 0.01). The arrhythmia induced was atrial flutter in 19/21 (91%) of atrial flutter patients, AF in 17/18 (94%) AF patients, both atrial flutter and AF in 5 AF/atrial flutter patients (100%). Two patients with atrial flutter had both AF/atrial flutter and 1 patient with AF had atrial flutter induced. The arrhythmia was induced from first stimulation site in 37 patients (85%) using a single extrastimuli in 9 (20%) patients, double extrastimuli 18 (41%) patients and triple extrastimuli in 10 (23%) patients. Two patients (5%) required stimulation from second site with two and three extrastimuli, respectively. The overall sensitivity and specificity of this stimulation protocol were 89% and 92%, respectively with a positive predictive accuracy of 95%.
我们试图定义一种用于诱发心房颤动[AF]和/或心房扑动的最低标准化方案。与心室刺激方案不同，用于诱发AF或心房扑动的刺激方案尚未得到严格评估。由于抑制可诱发的AF或心房扑动被用作药物治疗和消融治疗成功的终点之一，因此显然需要定义一种最低限度合适的电刺激方案来诱发AF或心房扑动。我们前瞻性地评估了70例患者，其中44例有自发性心房扑动或AF，26例为对照，无记录的房性心律失常。采用一种标准化的程控刺激方案，在两个心房驱动起搏周长下，在两个心房部位给予多达三次心房期外刺激，试图诱发持续性AF和心房扑动。研究终点是诱发持续性（>30秒）AF或心房扑动。39/44（89%）例患者和2/26（7%）例对照诱发了持续性AF或心房扑动（p<0.01）。在心房扑动患者中，19/21（91%）诱发的心律失常为心房扑动，17/18（94%）例AF患者诱发的是AF，5例AF/心房扑动患者（100%）诱发了心房扑动和AF。2例心房扑动患者同时诱发了AF/心房扑动，1例AF患者诱发了心房扑动。37例患者（85%）的心律失常从第一个刺激部位诱发，其中9例（20%）患者使用单次期外刺激，18例（41%）患者使用双次期外刺激，10例（23%）患者使用三次期外刺激。2例患者（5%）分别需要从第二个部位用两次和三次期外刺激进行刺激。该刺激方案的总体敏感性和特异性分别为89%和92%，阳性预测准确率为95%。
