O'Donnell David, Bourke John P, Furniss Steve S
Department of Academic Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
J Cardiovasc Electrophysiol. 2002 Nov;13(11):1111-7. doi: 10.1046/j.1540-8167.2002.01111.x.
This study analyzed the electrophysiologic properties of interatrial transseptal electrical conduction at Bachmann's bundle and the ostium of the coronary sinus (CS os) in response to pulmonary vein (PV) stimuli, which mimicked spontaneous ectopy.
Forty patients with atrial fibrillation (AF) referred for ablation (15 persistent AF and 25 paroxysmal AF) and 15 control patients were enrolled in the study. During decremental extra-stimulus pacing from the PVs, right atrial activation was analyzed using noncontact mapping and multipolar catheters. The refractory periods and conduction times were calculated for Bachmann's bundle, CS os, and left atrium. The dispersion of refractoriness was calculated as the difference between the refractory periods of Bachmann's bundle and the CS os. The refractory period at Bachmann's bundle was 244 msec in the persistent AF group, 213 msec in the paroxysmal AF group, and 199 msec for controls. The refractory period at the CS os was 220 msec in the persistent AF group, 201 msec in the paroxysmal AF group, and 193 msec for controls. The dispersion of refractoriness was 54 msec in the persistent AF group; this was significantly greater than in paroxysmal AF at 32 msec (P < 0.05) and controls at 13 msec (P < 0.01). During decremental pacing, lengthening of conduction times at both Bachmann's bundle and the CS os were significantly greater in the persistent AF group compared with paroxysmal AF or control groups. A higher dispersion of refractoriness was associated with a higher incidence of inducible AF and a lower rate of ablation success.
There are differences between the left to right interatrial electrical connections between patients with persistent AF, paroxysmal AF and controls.
本研究分析了在模拟自发性异位的肺静脉（PV）刺激下，巴赫曼束和冠状窦口（CS口）处房间隔跨隔电传导的电生理特性。
40例因房颤（AF）接受消融治疗的患者（15例持续性AF和25例阵发性AF）以及15例对照患者纳入本研究。在从肺静脉进行递减性额外刺激起搏期间，使用非接触式标测和多极导管分析右心房激活情况。计算巴赫曼束、CS口和左心房的不应期和传导时间。不应期离散度计算为巴赫曼束和CS口不应期之间的差值。持续性AF组中巴赫曼束的不应期为244毫秒，阵发性AF组为213毫秒，对照组为199毫秒。持续性AF组中CS口的不应期为220毫秒，阵发性AF组为201毫秒，对照组为193毫秒。持续性AF组的不应期离散度为54毫秒；这显著大于阵发性AF组的32毫秒（P<0.05）和对照组的13毫秒（P<0.01）。在递减起搏期间，持续性AF组中巴赫曼束和CS口的传导时间延长均显著大于阵发性AF组或对照组。较高的不应期离散度与可诱导性AF的较高发生率和较低的消融成功率相关。
持续性AF、阵发性AF患者与对照组之间的左右房间隔电连接存在差异。
