Vincenti Antonio, Brambilla Roberta, Fumagalli Maria Grazia, Merola Rita, Pedretti Stefano
Cardiology Department, Electrophysiology and Cardiac Pacing Unit, St Gerardo Hospitalvia Donizetti 106, 20052 Monza, MI, Italy.
Europace. 2006 Mar;8(3):204-10. doi: 10.1093/europace/euj043. Epub 2006 Feb 13.
The aim of this study was to evaluate the mechanisms of induction of paroxysmal atrial fibrillation (PAF) by analysis of its onset recorded on Holter monitoring (HM).
One hundred and seven HM were evaluated in 90 patients (mean age 67.7, cardiac disease in 31.1%), with one or more self-terminating episodes of PAF, lasting >or=30 s. Two hundred and thirty-three episodes of PAF were detected. A triggering premature atrial complex (PAC) was present in 222/233 episodes (95.3%); 118/233 episodes were preceded by a bradyarrhythmic event (BE) or a post-extrasystolic pause (50.6%). According to the polarity of the ectopic P-wave, triggering PACs were left atrial origin in 74.3%, right atrial in 15.3%, not determined in 10.4% of cases. Coupling interval (CI) of triggering PACs was shorter in episodes preceded by BEs; it was shorter than that of non-triggering PACs. Frequency of PACs was significantly higher in the hour preceding the onset of PAF. During the day, three periods of higher frequency of PAF onsets were found from noon to 2 p.m., 6 p.m. to 2 a.m., and 4 a.m. to 6 a.m. Heart rate variability analysis showed a vagal prevalence in the 5 min preceding the onset of arrhythmia, both in the time and in the frequency domain.
Paroxysmal atrial fibrillation is generally triggered by a PAC, with left atrial origin in two-thirds of cases: CI and neuroendocrine balance are factors affecting the induction of the arrhythmia.
本研究旨在通过分析动态心电图监测（HM）记录的阵发性心房颤动（PAF）发作情况来评估其诱发机制。
对90例患者（平均年龄67.7岁，31.1%患有心脏病）的107份动态心电图进行了评估，这些患者有一次或多次自行终止的PAF发作，持续时间≥30秒。共检测到233次PAF发作。222/233次发作（95.3%）存在触发房性早搏（PAC）；118/233次发作之前有缓慢性心律失常事件（BE）或早搏后停顿（50.6%）。根据异位P波的极性，74.3%的触发PAC起源于左心房，15.3%起源于右心房，10.4%的病例未确定起源。BE发作前的触发PAC的耦合间期（CI）较短；它比非触发PAC的耦合间期短。PAF发作前一小时PAC的频率显著更高。在一天中，发现PAF发作频率较高的三个时间段为中午至下午2点、下午6点至凌晨2点和凌晨4点至6点。心率变异性分析显示，在心律失常发作前5分钟，无论是在时域还是频域，迷走神经均占优势。
阵发性心房颤动通常由PAC触发，三分之二的病例起源于左心房：CI和神经内分泌平衡是影响心律失常诱发的因素。
