Jaïs Pierre, Hocini Mélèze, Macle Laurent, Choi Kee-Joon, Deisenhofer Isabel, Weerasooriya Rukshen, Shah Dipen C, Garrigue Stéphane, Raybaud Florence, Scavee Christophe, Le Metayer Philippe, Clémenty Jacques, Haïssaguerre Michel
Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
Circulation. 2002 Nov 5;106(19):2479-85. doi: 10.1161/01.cir.0000036744.39782.9f.
Atrial fibrillation (AF) is frequently initiated from pulmonary veins (PVs), but little is known of the electrophysiological properties of PVs.
Two groups were studied: 28 patients (49+/-13 years old) with paroxysmal AF and 20 control patients (49+/-14 years old) without AF. Effective and functional refractory period and conduction time from PV to left atrium (LA) were compared in the 2 groups by use of programmed stimulation with a single extrastimulus in the PVs and LA. In the AF group, the venous effective refractory periods (ERPs) were shorter than that of the LA: 185+/-71 versus 253+/-21 ms, P<0.001, whereas in the control group, they were longer (282+/-45 versus 253+/-41 ms, P=0.009). The venous ERPs and functional refractory periods in patients with AF were also shorter than that observed in control subjects (185+/-71 versus 282+/-45 ms and 210+/-77 versus 315+/-43 ms, respectively, P<0.001), whereas LA ERPs were not significantly different. Decremental conduction in PVs was more frequent (93% versus 56%, P=0.01) and had a greater increment (102+/-65 versus 42+/-40 ms, P<0.001) in patients with AF. Finally, AF was more frequently induced when pacing was performed in PVs (22 of 90) versus LA (1 of 81) in patients with AF (P<0.001).
The PVs of patients with AF exhibited distinctive electrophysiological properties, which were strikingly different from those of patients devoid of AF, potentially explaining their arrhythmogenicity.
心房颤动（AF）常起源于肺静脉（PVs），但对肺静脉的电生理特性了解甚少。
研究了两组：28例阵发性AF患者（49±13岁）和20例无AF的对照患者（49±14岁）。通过在肺静脉和左心房（LA）中使用单个额外刺激的程控刺激，比较两组从肺静脉到左心房的有效不应期、功能不应期和传导时间。在AF组中，静脉有效不应期（ERPs）短于左心房：185±71对253±21毫秒，P<0.001，而在对照组中，静脉有效不应期更长（282±45对253±41毫秒，P=0.009）。AF患者的静脉有效不应期和功能不应期也短于对照组（分别为185±71对282±45毫秒和210±77对315±43毫秒，P<0.001），而左心房有效不应期无显著差异。AF患者肺静脉递减传导更频繁（93%对56%，P=0.01）且增加幅度更大（102±65对42±40毫秒，P<0.001）。最后，AF患者在肺静脉起搏时（90例中的22例）比在左心房起搏时（81例中的1例）更频繁地诱发AF（P<0.001）。
AF患者的肺静脉表现出独特的电生理特性，与无AF患者的电生理特性显著不同，这可能解释了它们的致心律失常性。
