Ogawa Masahiro, Kumagai Koichiro, Gondo Naoki, Matsumoto Naomichi, Suyama Kazuhiro, Saku Keijiro
Department of Cardiology, Fukuoka University School of Medicine, Japan.
J Cardiovasc Electrophysiol. 2002 Feb;13(2):110-7. doi: 10.1046/j.1540-8167.2002.00110.x.
Heterogeneity of ventricular repolarization plays a major role in reentrant tachyarrhythmias in cardiac tissue. However, the role of atrial repolarization added activation time (AT) to refractoriness in atrial vulnerability has not been investigated in detail.
The study population consisted of 34 patients: 18 with atrial fibrillation (AF) and 16 without AF (control group). The effective refractory periods (ERPs) in the right atrial appendage, low lateral right atrium, high right septum, and distal coronary sinus, and ATs from P wave onset to each electrogram during sinus rhythm and right atrial appendage, low lateral right atrial, high right septal, distal coronary sinus, and biatrial pacing were measured. Atrial recovery time, defined as the sum of AT and ERP, and its dispersions during sinus rhythm, right atrial appendage, low lateral right atrial, high right septal, distal coronary sinus, and biatrial pacing were calculated. Both ERP dispersion and atrial recovery time dispersion during sinus rhythm were significantly greater in the AF group than in the control group. Atrial recovery time dispersion during distal coronary sinus, high right septal, or biatrial pacing was significantly smaller than that during right atrial appendage or low lateral right atrial pacing in each group. In particular, atrial recovery time dispersion during distal coronary sinus pacing was the smallest of the five pacing methods in the AF group. P wave duration during biatrial or high right septal pacing was significantly shorter than during right atrial appendage, low lateral right atrial, or distal coronary sinus pacing in each group.
Atrial recovery time dispersion is suitable as an electrophysiologic parameter of atrial vulnerability. Distal coronary sinus pacing may prevent AF by increasing homogeneity of atrial repolarization, whereas biatrial and high right septal pacing contribute not only homogeneity of atrial repolarization but also improvement of atrial depolarization.
心室复极的异质性在心脏组织的折返性快速心律失常中起主要作用。然而，心房复极加激活时间（AT）对心房易损性不应期的作用尚未得到详细研究。
研究人群包括34例患者：18例心房颤动（AF）患者和16例无AF患者（对照组）。测量右心耳、右心房下外侧、右心房高间隔和冠状窦远端的有效不应期（ERP），以及窦性心律和右心耳、右心房下外侧、右心房高间隔、冠状窦远端和双房起搏期间从P波起始到每个心电图的AT。计算心房恢复时间，定义为AT与ERP之和，以及窦性心律、右心耳、右心房下外侧、右心房高间隔、冠状窦远端和双房起搏期间的离散度。AF组窦性心律期间的ERP离散度和心房恢复时间离散度均显著大于对照组。每组中，冠状窦远端、右心房高间隔或双房起搏期间的心房恢复时间离散度显著小于右心耳或右心房下外侧起搏期间。特别是，AF组中冠状窦远端起搏期间的心房恢复时间离散度是五种起搏方法中最小的。每组中，双房或右心房高间隔起搏期间的P波持续时间显著短于右心耳、右心房下外侧或冠状窦远端起搏期间。
心房恢复时间离散度适合作为心房易损性的电生理参数。冠状窦远端起搏可通过增加心房复极的均匀性来预防AF，而双房和右心房高间隔起搏不仅有助于心房复极的均匀性，还能改善心房去极化。
