Elesber Ahmad A, Rosales Ana Gabriela, Shen Win-Kuang, Malouf Joseph F, Hodge David O, Ammash Naser M, Chandrasekaran Krishnaswamy, Gersh Bernard J, Hammill Stephen C, Friedman Paul A
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pacing Clin Electrophysiol. 2005 Feb;28(2):135-9. doi: 10.1111/j.1540-8159.2005.09478.x.
Atrial remodeling secondary to atrial fibrillation (AF) may be important in the arrhythmogenic process. Unfortunately, the study of electrophysiologic remodeling in humans has been limited by the invasive nature of most tests of electrophysiologic characteristics. We sought to determine whether changes in atrial electrophysiology occur acutely (within the first hour) after cardioversion and whether these changes could be detected noninvasively by measuring the signal-averaged P-wave.
The filtered P-wave duration (FPD) was measured by signal-averaged electrocardiography (ECG) at 20 and 60 minutes after cardioversion in 46 patients with AF, and the difference between the two values was calculated. The root-mean-square voltage of the terminal 40 ms of the signal-averaged P-wave at 20 and 60 minutes and the difference between them were also determined.
The FPD at 20 minutes was significantly different from that at 60 minutes (153.0 +/- 19.1 vs 159.7 +/- 24.8 ms; P = 0.02). In a univariate linear regression model, none of the clinical variables studied was significantly associated with the change in FPD. The root-mean-square voltage at 20 minutes was not significantly different from that at 60 minutes (5.8 +/- 3.0 vs 5.5 +/- 2.7; P = 0.14).
We conclude that significant changes in atrial electrophysiology occur within the first hour after cardioversion of AF. These changes can be detected by measuring the FPD.
心房颤动（AF）继发的心房重构在心律失常发生过程中可能起重要作用。不幸的是，人类电生理重构的研究受到大多数电生理特性检测方法侵入性的限制。我们试图确定电复律后心房电生理变化是否在急性期（第一小时内）发生，以及这些变化是否可以通过测量信号平均P波无创检测到。
对46例房颤患者在电复律后20分钟和60分钟通过信号平均心电图（ECG）测量滤波后的P波时限（FPD），并计算两个值之间的差异。还测定了电复律后20分钟和60分钟时信号平均P波终末40ms的均方根电压及其差值。
20分钟时的FPD与60分钟时显著不同（153.0±19.1 vs 159.7±24.8ms；P = 0.02）。在单变量线性回归模型中，所研究的临床变量均与FPD的变化无显著相关性。20分钟时的均方根电压与60分钟时无显著差异（5.8±3.0 vs 5.5±2.7；P = 0.14）。
我们得出结论，房颤电复律后第一小时内心房电生理发生显著变化。这些变化可通过测量FPD检测到。
