有阵发性心房颤动病史患者中，房性早搏P波与前序窦性复合波在形态和时限上的差异。
Differences in the morphology and duration between premature P waves and the preceding sinus complexes in patients with a history of paroxysmal atrial fibrillation.
作者信息
Dilaveris Polychronis E, Pantazis Antonios, Zervopoulos George, Kallikazaros John, Stefanadis Christodoulos, Toutouzas Pavlos K
机构信息
Department of Cardiology, Pammakaristos Hospital, Athens, Greece.
出版信息
Clin Cardiol. 2003 Jul;26(7):341-7. doi: 10.1002/clc.4950260709.
BACKGROUND
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Experimental and human mapping studies have demonstrated that perpetuation of AF is due to the presence of multiple reentrant wavelets with various sizes in the right and left atria.
HYPOTHESIS
Atrial fibrillation may be induced by atrial ectopic beats originating in the pulmonary veins, and premature P-wave (PPW) patterns may help to identify the source of firing.
METHODS
To evaluate the morphology and duration of PPWs, 12-lead digital electrocardiogram (ECG) strips containing clearly definable PPWs not merging with the preceding T waves were obtained in 25 patients with AF history (9 men, mean age 59.5 +/- 2.2 years) and 25 subjects without any previous AF history (11 men, mean age 53.6 +/- 25 years). The polarity of PPWs was evaluated in all 12 ECG leads. Previously described indices, such as P maximum, P dispersion (= P maximum-P minimum), P mean, and P standard deviation were also calculated.
RESULTS
Premature P-wave patterns were characterized by more positive P waves in lead V1. All P-wave analysis indices were significantly higher in patients with AF than in controls when calculated in the sinus beat, whereas they did not differ between the two groups when calculated in the PPW. P-wave indices did not differ between the PPW and the sinus either patients with AF or controls, except for P mean, which was significantly higher in the sinus (110.1 +/- 1.7 ms) than in the PPW (100 +/- 2 ms) only in patients with AF (p = 0.001).
CONCLUSION
The evaluation of PPW patterns is only feasible in a small percentage of short-lasting digital 12-lead ECG recordings containing ectopic atrial beats. Premature P wave patterns characterized by more positive P waves in lead V1, which indicates a left atrial origin in the ectopic foci. The observed differences in P-wave analysis indices between patients with AF and controls and between sinus beats and PPWs may be attributed to the presence of electrophysiologic changes in the atrial substrate.
背景
心房颤动（AF）是临床实践中最常见的心律失常。实验和人体标测研究表明，房颤的持续存在是由于左右心房中存在多个大小各异的折返小波。
假设
房颤可能由起源于肺静脉的房性早搏诱发，过早P波（PPW）形态可能有助于识别激动起源部位。
方法
为评估PPW的形态和时限，从25例有房颤病史的患者（9例男性，平均年龄59.5±2.2岁）和25例无房颤病史的受试者（11例男性，平均年龄53.6±25岁）中获取12导联数字心电图（ECG）记录条，这些记录条包含清晰可辨且未与前一个T波融合的PPW。在所有12个ECG导联中评估PPW的极性。还计算了先前描述的指标，如P最大值、P离散度（=P最大值 - P最小值）、P平均值和P标准差。
结果
过早P波形态的特征是V1导联中P波更正。在窦性心律时计算，所有P波分析指标在房颤患者中均显著高于对照组，而在PPW中计算时，两组之间无差异。除P平均值外，房颤患者和对照组的PPW与窦性心律之间的P波指标也无差异，仅在房颤患者中，窦性心律时的P平均值（110.1±1.7毫秒）显著高于PPW时的P平均值（100±2毫秒）（p = 0.001）。
结论
仅在一小部分包含房性早搏的短暂数字12导联ECG记录中，评估PPW形态才可行。以V1导联中P波更正为特征的过早P波形态表明异位起搏点起源于左心房。房颤患者与对照组之间以及窦性心律与PPW之间观察到的P波分析指标差异可能归因于心房基质中存在的电生理变化。
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