Endoh Yasuhiro, Nakamura Ayako, Suzuki Tsuyoshi, Mizuno Masayuki, Takara Ayako, Ota Yoshimi, Kasanuki Hiroshi
Department of Cardiology, Saiseikai Kurihashi Hospital, Tokyo, Japan.
Circ J. 2003 Jun;67(6):485-9. doi: 10.1253/circj.67.485.
The present study investigated both the clinical significance of atrial fibrillation (AF) before right atrial appendage (RAA) pacing and the influence of prolonged P wave on AF occurrence in RAA-paced patients with sick sinus syndrome (SSS). Fifty-seven patients (age 68+/-10 years; 19 men, 38 women) with SSS who underwent RAA pacing were divided into 2 groups: 23 patients without AF before pacing (I + II; Rubenstein I or II) and 34 patients with AF before pacing (III; Rubenstein III). The P wave duration in intrinsic rhythm and with RAA pacing were measured on the standard electrocardiography in leads II and V(1) with the use of a digitizing tablet. Group III was further subdivided into 2 groups: 20 patients (IIIb) with a paced P wave >130 ms in both leads II and V(1) and the other 14 patients (IIIa). The duration of the intrinsic P wave in leads II and V(1) was significantly greater in group III than in group I + II (119+/-20 vs 108+/-21 ms, p=0.0417, 106+/-16 vs 95+/-21 ms, p=0.0258, respectively). During the follow-up of 40+/-21 months, AF recurrence was significantly higher in group IIIb than in groups IIIa and I + II (17/20 vs 5/14 vs 2/23 p<0.0001). A few occurrences of AF were observed by conventional RAA pacing in patients without AF before pacing. However, SSS with AF before pacing caused a significant intra-atrial conduction disturbance and a high incidence of AF recurrence after implantation of RAA pacing, especially in patients with a prolonged paced P wave, in whom new pacing modalities may be needed to shorten paced P wave duration and prevent AF.
本研究调查了右心耳（RAA）起搏前房颤（AF）的临床意义以及病态窦房结综合征（SSS）患者RAA起搏时延长的P波对AF发生的影响。57例接受RAA起搏的SSS患者（年龄68±10岁；男性19例，女性38例）被分为2组：23例起搏前无AF的患者（I + II；鲁宾斯坦I或II）和34例起搏前有AF的患者（III；鲁宾斯坦III）。使用数字化平板电脑在标准心电图的II导联和V1导联上测量固有心律和RAA起搏时的P波持续时间。III组进一步分为2组：20例（IIIb）在II导联和V1导联起搏P波均>130 ms的患者和另外14例（IIIa）患者。III组II导联和V1导联固有P波的持续时间明显长于I + II组（分别为119±20 vs 108±21 ms，p = 0.0417；106±16 vs 95±21 ms，p = 0.0258）。在40±21个月的随访期间，IIIb组AF复发率明显高于IIIa组和I + II组（17/20 vs 5/14 vs 2/23，p<0.0001）。在起搏前无AF的患者中，通过传统RAA起搏观察到少数AF发作。然而，起搏前有AF的SSS会导致明显的心房内传导障碍，并且RAA起搏植入后AF复发率很高，尤其是在起搏P波延长的患者中，可能需要新的起搏方式来缩短起搏P波持续时间并预防AF。
