Hocini Mélèze, Sanders Prashanthan, Deisenhofer Isabel, Jaïs Pierre, Hsu Li-Fern, Scavée Christophe, Weerasoriya Rukshen, Raybaud Florence, Macle Laurent, Shah Dipen C, Garrigue Stéphane, Le Metayer Philippe, Clémenty Jacques, Haïssaguerre Michel
Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604, Bordeaux-Pessac, France.
Circulation. 2003 Sep 9;108(10):1172-5. doi: 10.1161/01.CIR.0000090685.13169.07. Epub 2003 Sep 2.
Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an indication for pacemaker implantation. We evaluated sinus node function and clinical outcome in patients with prolonged sinus pauses on termination of arrhythmia who underwent ablation of paroxysmal AF.
Twenty patients with paroxysmal AF and prolonged sinus pauses (> or =3 seconds) on termination of AF underwent ablation between May 1995 and November 2002. Patients with sinus pauses independent of episodes of AF were excluded from the analysis. The procedure included pulmonary vein and linear atrial ablation. After ablation, sinus node function was assessed during the first week and at 1, 3, and 6 months, by 24-hour ambulatory monitoring to determine the mean heart rate and heart rate range, and by exercise testing to determine the maximal heart rate. Corrected sinus node recovery time was determined at the completion of ablation and at 24.0+/-11.3 months at 600 and 400 ms. After AF ablation, there was a significant improvement of sinus node function, with an increase in the mean heart rate (P=0.001), maximal heart rate (P<0.0001), and heart rate range (P<0.0001). The corrected sinus node recovery time decreased in all patients evaluated at 600 ms (P=0.016) and 400 ms (P=0.019). At 26.0+/-17.6 months, 18 patients (85%) had no recurrence of AF (in the absence of medication), with no symptoms attributable to bradycardia or sinus pauses on ambulatory monitoring. Two patients had infrequent episodes of AF, 1 requiring pacemaker implantation.
Prolonged sinus pauses after paroxysms of AF may result from depression of sinus node function that can be eliminated by curative ablation of AF. This is accompanied by improvement in parameters of sinus node function, suggesting reverse remodeling of the sinus node.
房颤（AF）终止时出现有症状的长时间窦性停搏是植入起搏器的指征。我们评估了因心律失常终止时出现长时间窦性停搏而接受阵发性房颤消融术的患者的窦房结功能及临床结局。
1995年5月至2002年11月期间，20例阵发性房颤且房颤终止时出现长时间窦性停搏（≥3秒）的患者接受了消融术。窦性停搏与房颤发作无关的患者被排除在分析之外。手术包括肺静脉和线性心房消融。消融术后，在第一周以及1、3和6个月时，通过24小时动态监测来评估窦房结功能，以确定平均心率和心率范围，并通过运动试验来确定最大心率。在消融完成时以及24.0±11.3个月时，分别在600毫秒和400毫秒测定校正窦房结恢复时间。房颤消融术后，窦房结功能有显著改善，平均心率（P=0.001）、最大心率（P<0.0001）和心率范围（P<0.0001）均增加。在600毫秒（P=0.016）和400毫秒（P=0.019）评估的所有患者中，校正窦房结恢复时间均缩短。在26.0±17.6个月时，18例患者（85%）未出现房颤复发（未使用药物），动态监测未发现因心动过缓或窦性停搏引起的症状。2例患者有偶发房颤发作，1例需要植入起搏器。
阵发性房颤后出现的长时间窦性停搏可能是由于窦房结功能受抑制所致，而房颤的根治性消融可消除这种抑制。这伴随着窦房结功能参数的改善，提示窦房结发生了逆向重构。
