Knackstedt Christian, Visser Laurent, Plisiene Jurgita, Zarse Markus, Waldmann Matthias, Mischke Karl, Koch Karl-Christian, Hoffmann Rainer, Franke Andreas, Hanrath Peter, Schauerte Patrick
Technical University RWTH Aachen, Department of Cardiology, Aachen, Germany.
Pacing Clin Electrophysiol. 2003 Jun;26(6):1371-8. doi: 10.1046/j.1460-9592.2003.t01-1-00196.x.
Ectopic beats originating from sleeves of atrial tissue within the pulmonary veins (PVs) can induce and sustain paroxysmal atrial fibrillation (AF). Left atrial stretch and dilatation favors the development of atrial ectopy and AF. Similarly, PV dilatation, if present, might trigger PV ectopy in patients with AF. This study was designed to evaluate whether PV dilatation is present in patients with nonfocal AF and whether the PV diameter correlates to the left atrial diameter (LAD). The diameters of the right superior (RSPV) and left superior PV (LSPV) were measured at the ostium and at a depth of 1 cm in 170 patients (AF, n = 75; sinus rhythm [SR], n = 95) using transesophageal echocardiography. The LAD was determined by transthoracic echocardiography. The diameters of the PVs were significantly larger in patients with AF than in patients with SR (LSPV(ostium): AF 13.6 +/- 3.5 mm vs SR 10.6 +/- 2.7 mm, P < 0.001; LSVP(1cm): AF 12.5 +/- 2.9 mm vs SR 10.2 +/- 2.5 mm, P < 0.001; RSPV(ostium): AF 13.9 +/- 3.5 mm vs SR 11.7 +/- 2.9 mm, P < 0.001; RSVP(1cm): AF 12.8 +/- 2.8 mm vs SR 10.6 +/- 2.6 mm, P < 0.05). Similarly, LAD was larger in patients with AF (44.7 +/- 7.7 mm) as compared to patients with SR (38.8 +/- 6.8 mm, P < 0.001). Neither for the SR nor the AF group did the PV size correlate to the LAD. AF is associated with a significant enlargement of the RSPV, LSPV, and LAD. There is no correlation between LAD and PV diameters. This raises the question whether PV dilatation in patients with AF is a cause or a consequence of AF and whether it may contribute to the development and perpetuation of AF.
源自肺静脉（PVs）内心房组织袖套的异位搏动可诱发并维持阵发性心房颤动（AF）。左心房的拉伸和扩张有利于心房异位搏动和AF的发展。同样，如果存在PV扩张，可能会触发AF患者的PV异位搏动。本研究旨在评估非局灶性AF患者是否存在PV扩张，以及PV直径是否与左心房直径（LAD）相关。使用经食管超声心动图测量了170例患者（AF患者75例，窦性心律[SR]患者95例）右肺上静脉（RSPV）和左肺上静脉（LSPV）在开口处及1cm深度处的直径。通过经胸超声心动图确定LAD。AF患者的PV直径显著大于SR患者（LSPV（开口处）：AF组13.6±3.5mm，SR组10.6±2.7mm，P<0.001；LSVP（1cm处）：AF组12.5±2.9mm，SR组10.2±2.5mm，P<0.001；RSPV（开口处）：AF组13.9±3.5mm，SR组11.7±2.9mm，P<0.001；RSVP（1cm处）：AF组12.8±2.8mm，SR组10.6±2.6mm，P<0.05）。同样，AF患者的LAD（44.7±7.7mm）大于SR患者（38.8±6.8mm，P<0.001）。无论是SR组还是AF组，PV大小均与LAD无关。AF与RSPV、LSPV和LAD的显著增大相关。LAD与PV直径之间无相关性。这就提出了一个问题，即AF患者的PV扩张是AF的原因还是结果，以及它是否可能促进AF的发生和持续。
