病态窦房结综合征患者右心房内心内膜电图异常的不同分布
Different distribution of abnormal endocardial electrograms within the right atrium in patients with sick sinus syndrome.
作者信息
Centurion O A, Fukatani M, Konoe A, Tanigawa M, Shimizu A, Isomoto S, Kaibara M, Hashiba K
机构信息
Third Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
出版信息
Br Heart J. 1992 Dec;68(6):596-600. doi: 10.1136/hrt.68.12.596.
BACKGROUND
Prolonged and fractionated right atrial endocardial electrograms are characteristic of paroxysmal atrial fibrillation (idiopathic or associated with sick sinus syndrome). The distribution of these abnormal atrial electrograms within the right atrium and the way it is related to the likelihood that patients with sick sinus syndrome will develop paroxysmal atrial fibrillation was studied.
METHODS
Endocardial catheter mapping of the right atrium during sinus rhythm was performed in 41 control patients with normal sinus node function and without paroxysmal atrial fibrillation, in 33 patients with sick sinus syndrome but without tachycardia, and in 27 patients with sick sinus syndrome and paroxysmal atrial fibrillation (group 3). The bipolar electrograms were recorded at 12 sites in the right atrium and an abnormal atrial electrogram was defined as lasting > or = 100 ms and/or showing eight or more fragmented deflections.
RESULTS
1195 atrial endocardial electrograms were assessed and quantitatively measured. In patients with sick sinus syndrome and paroxysmal atrial fibrillation 54% of the abnormal atrial electrograms were recorded from the high right atrium, 28% from the mild right atrium, and 18% from the low right atrium. However, in patients with sick sinus syndrome without tachycardia 78% of the abnormal atrial electrograms were recorded from the high right atrium and 22% from the mid right atrium. No abnormal electrograms were recorded from the low right atrium.
CONCLUSIONS
In patients with sick sinus syndrome without tachycardia abnormal atrial electrograms generally came from the high right atrium but in patients with sick sinus syndrome and paroxysmal atrial fibrillation abnormal atrial electrograms were more widely distributed in the right atrium. In patients with sick sinus syndrome the greater the extent of the compromised atrial muscle, the greater the likelihood that paroxysmal atrial fibrillation will develop.
背景
延长且碎裂的右心房心内膜电图是阵发性心房颤动（特发性或与病态窦房结综合征相关）的特征。本研究探讨了这些异常心房电图在右心房内的分布情况以及它与病态窦房结综合征患者发生阵发性心房颤动可能性之间的关系。
方法
对41例窦房结功能正常且无阵发性心房颤动的对照患者、33例有病态窦房结综合征但无心动过速的患者以及27例有病态窦房结综合征且有阵发性心房颤动的患者（第3组）在窦性心律时进行右心房心内膜导管标测。在右心房的12个部位记录双极电图，异常心房电图定义为持续时间≥100毫秒和/或显示8个或更多的碎裂波。
结果
共评估并定量测量了1195份心房心内膜电图。在有病态窦房结综合征且有阵发性心房颤动的患者中，54%的异常心房电图记录于右心房高位，28%记录于右心房中部，18%记录于右心房低位。然而，在有病态窦房结综合征但无心动过速的患者中，78%的异常心房电图记录于右心房高位，22%记录于右心房中部。右心房低位未记录到异常电图。
结论
在有病态窦房结综合征但无心动过速的患者中，异常心房电图通常来自右心房高位，但在有病态窦房结综合征且有阵发性心房颤动的患者中，异常心房电图在右心房内分布更广泛。在有病态窦房结综合征的患者中，心房肌受损程度越大，发生阵发性心房颤动的可能性就越大。
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