Dabrowska-Kugacka Alicja, Lewicka-Nowak Ewa, Kutarski Andrzej, Zagozdzon Paweł, Swiatecka Grazyna
II Dept. of Cardiology, Medical University of Gdańsk, Kieturakisa 1, 80-742 Gdańsk, Poland.
Pacing Clin Electrophysiol. 2003 Jan;26(1P2):278-83. doi: 10.1046/j.1460-9592.2003.00032.x.
Recently, multisite atrial pacing has been suggested as an alternative therapy to prevent recurrences of paroxysmal atrial fibrillation (PAF). A study was conducted to compare the acute effects of biatrial (BiA), left atrial (LA), and right atrial appendage (RAA) pacing on cardiac hemodynamics. In 14 patients with PAF and a BiA pacemaker (with leads in the RAA and coronary sinus), cardiac output (CO), right (RV) and left ventricular (LV) filling, RA-LA contraction delay [PA(m-t)] and the difference in A wave duration [Adif(m-p)] at the level of the mitral valve (Adurm) and pulmonary veins (Adurp) during RAA, BiA, and LA pacing were examined by echo-Doppler measurements. The atrial pacing site did not affect the CO. LA, but not BiA, pacing resulted in delayed RA contraction in comparison with RAA pacing with significant diminution of the RA contribution to RV filling. With LA pacing, the usual right-to-left atrial contraction sequence was reversed (PA(m-t): 8 +/- 7 ms control; 5 +/- 30 ms RAA; -10 +/- 21 ms BiA; -72 +/- 36 ms LA; LA versus control versus RAA and versus BiA, P < 0.001. LA and BiA pacing prolonged Adurp (LA 186 +/- 52 ms, BiA 180 +/- 45 ms, RAA 153 +/- 49 ms; LA and BiA vs RAA, P < 0.01). Thus Adurp exceeded Adurm [Adif (m-p): control 38 +/- 40 ms, RAA 7 +/- 42 ms, BiA -12 +/- 43 ms, LA -20 +/- 44 ms; control vs RAA, BiA, and LA; and RAA vs LA, P < 0.05]. The study showed that (1) the atrial pacing site has no influence on global cardiac performance; (2) the hemodynamic effect of BiA pacing is not superior to that of RAA pacing, and LA pacing can even be deleterious; (3) LA pacing reverses the usual right-to-left atrial contraction sequence and reduces the RA contribution to RV filling; (4) BiA and LA pacing prolong Adurp due to an altered activation pattern, decreased pulmonary venous return, or increased LA pressure.
最近，多部位心房起搏已被提议作为预防阵发性心房颤动（PAF）复发的替代疗法。进行了一项研究，比较双心房（BiA）、左心房（LA）和右心耳（RAA）起搏对心脏血流动力学的急性影响。在14例植入BiA起搏器（电极置于RAA和冠状窦）的PAF患者中，通过超声多普勒测量检查了RAA、BiA和LA起搏期间的心输出量（CO）、右心室（RV）和左心室（LV）充盈、RA-LA收缩延迟[PA（m-t）]以及二尖瓣水平（Adurm）和肺静脉水平（Adurp）处A波持续时间的差异[Adif（m-p）]。心房起搏部位不影响CO。与RAA起搏相比，LA起搏而非BiA起搏导致RA收缩延迟，RA对RV充盈的贡献显著减少。LA起搏时，通常的右向左心房收缩顺序发生逆转（PA（m-t）：对照组8±7毫秒；RAA组5±30毫秒；BiA组-10±21毫秒；LA组-72±36毫秒；LA与对照组、RAA组和BiA组相比，P<0.001）。LA和BiA起搏延长了Adurp（LA为186±52毫秒，BiA为180±45毫秒，RAA为153±49毫秒；LA和BiA与RAA相比，P<0.01）。因此，Adurp超过了Adurm[Adif（m-p）：对照组38±40毫秒，RAA组7±42毫秒，BiA组-12±43毫秒，LA组-20±44毫秒；对照组与RAA组、BiA组和LA组相比；以及RAA组与LA组相比，P<0.05]。该研究表明：（1）心房起搏部位对整体心脏功能无影响；（2）BiA起搏的血流动力学效应不优于RAA起搏，LA起搏甚至可能有害；（3）LA起搏逆转了通常的右向左心房收缩顺序，并减少了RA对RV充盈的贡献；（4）BiA和LA起搏由于激活模式改变、肺静脉回流减少或LA压力增加而延长了Adurp。
