Misier A R, Opthof T, van Hemel N M, Defauw J J, de Bakker J M, Janse M J, van Capelle F J
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Am Coll Cardiol. 1992 Jun;19(7):1531-5. doi: 10.1016/0735-1097(92)90614-s.
The average interval between local depolarizations during atrial fibrillation, the so-called atrial fibrillation interval, was used as an index for local "refractoriness." This was based on the assumption that during fibrillation, cells are reexcited as soon as their refractory period ends. A very good correlation was found between refractory periods determined with the extrastimulus technique at a basic cycle length of 400 ms and atrial fibrillation intervals measured at the same epicardial sites of the right atrium. This new technique was used to assess dispersion in atrial fibrillation intervals in 10 patients with idiopathic paroxysmal atrial fibrillation and in a control group of 6 patients who were undergoing cardiac surgery. After a routine median sternotomy a multiterminal grid with up to 40 electrodes was placed over the right atrium, and atrial fibrillation was induced by premature stimulation. The average fibrillation interval in the test group, recorded at 247 sites, was 152 +/- 3 ms and that in the control group, recorded at 118 sites, was 176 +/- 8.1 ms (p less than 0.05). Dispersion in atrial fibrillation intervals, defined as the variance of the fibrillation intervals at all the recording sites, was three times larger in the group with paroxysmal atrial fibrillation than in the control group. This study suggests that both a shorter refractory period and a larger dispersion in refractoriness are responsible for the recurrence of atrial fibrillation.
心房颤动期间局部去极化之间的平均间隔，即所谓的心房颤动间隔，被用作局部“不应期”的指标。这是基于这样的假设：在颤动期间，细胞一旦不应期结束就会再次被激发。在400毫秒的基础周期长度下，用额外刺激技术测定的不应期与在右心房相同心外膜部位测量的心房颤动间隔之间发现了非常好的相关性。这项新技术被用于评估10例特发性阵发性心房颤动患者和6例接受心脏手术的对照组患者心房颤动间隔的离散度。在常规正中胸骨切开术后，将一个最多有40个电极的多端网格置于右心房上方，通过过早刺激诱发心房颤动。试验组在247个部位记录的平均颤动间隔为152±3毫秒，对照组在118个部位记录的平均颤动间隔为176±8.1毫秒（p<0.05）。心房颤动间隔的离散度定义为所有记录部位颤动间隔的方差，阵发性心房颤动组比对照组大三倍。这项研究表明，较短的不应期和较大的不应期离散度都是心房颤动复发的原因。
