Sanders Prashanthan, Nalliah Chrishan J, Dubois Rémi, Takahashi Yoshihide, Hocini Mélèze, Rotter Martin, Rostock Thomas, Sacher Fréderic, Hsu Li-Fern, Jönsson Anders, O'Neill Mark D, Jaïs Pierre, Haïssaguerre Michel
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
J Cardiovasc Electrophysiol. 2006 Sep;17(9):965-72. doi: 10.1111/j.1540-8167.2006.00546.x.
The pulmonary veins (PVs) are a dominant source of triggers initiating atrial fibrillation (AF). While recent evidence implicates these structures in the maintenance of paroxysmal AF, their role in permanent AF is not known. The current study aims to compare the contribution of PV activity to the maintenance of paroxysmal and permanent AF.
Thirty-four patients with paroxysmal AF (n = 20) or permanent AF (n = 14) undergoing ablation were studied. Prior to ablation, 32 seconds of electrograms were acquired from each PV and the coronary sinus (CS). The frequency of activity of each PV and CS was defined as the highest amplitude frequency on spectral analysis. The effects of ablation on the AF cycle length (AFCL) and frequency and on AF termination were determined. Significant differences were observed between paroxysmal and permanent AF. Paroxysmal AF demonstrates higher frequency PV activity (11.0 +/- 3.1 vs 8.8 +/- 3.0 Hz; P = 0.0003) but lower CS frequency (5.8 +/- 1.2 vs 6.9 +/- 1.4 Hz; P = 0.01) and longer AFCL (182 +/- 17 vs 158 +/- 21 msec; P = 0.002), resulting in greater PV to atrial frequency gradient (7.2 +/- 2.2 vs 4.2 +/- 2.9 Hz; P = 0.006). PV isolation in paroxysmal AF resulted in a greater decrease in atrial frequency (1.0 +/- 0.7 vs -0.05 +/- 0.4 Hz; P < 0.0001), greater prolongation of the AFCL (49 +/- 35 vs 5 +/- 6 msec; P < 0.0001), and more frequent AF termination (11/20 vs 0/14; P = 0.0007) compared to permanent AF.
Paroxysmal AF is associated with higher frequency PV activity and lesser CS frequency compared to permanent AF. Isolation of the PVs had a greater impact on the fibrillatory process in paroxysmal AF compared to permanent AF, suggesting that while the PVs have a role in maintaining paroxysmal AF, these structures independently contribute less to the maintenance of permanent AF.
肺静脉（PVs）是引发心房颤动（AF）的主要触发因素来源。虽然最近的证据表明这些结构参与阵发性房颤的维持，但其在永久性房颤中的作用尚不清楚。本研究旨在比较肺静脉活动对阵发性房颤和永久性房颤维持的贡献。
对34例接受消融治疗的阵发性房颤患者（n = 20）或永久性房颤患者（n = 14）进行了研究。在消融前，从每个肺静脉和冠状窦（CS）获取32秒的心电图。每个肺静脉和冠状窦的活动频率定义为频谱分析中最高振幅频率。确定消融对房颤周期长度（AFCL）、频率和房颤终止的影响。阵发性房颤和永久性房颤之间观察到显著差异。阵发性房颤表现出更高频率的肺静脉活动（11.0±3.1对8.8±3.0 Hz；P = 0.0003），但冠状窦频率较低（5.8±1.2对6.9±1.4 Hz；P = 0.01），房颤周期长度更长（182±17对158±21毫秒；P = 0.002），导致肺静脉与心房频率梯度更大（7.2±2.2对4.2±2.9 Hz；P = 0.006）。与永久性房颤相比，阵发性房颤中肺静脉隔离导致心房频率下降更大（1.0±0.7对 -0.05±0.4 Hz；P < 0.0001），房颤周期长度延长更大（49±35对5±6毫秒；P < 0.0001），房颤终止更频繁（11/20对0/14；P = 0.0007）。
与永久性房颤相比，阵发性房颤与更高频率的肺静脉活动和更低的冠状窦频率相关。与永久性房颤相比，肺静脉隔离对阵发性房颤的颤动过程影响更大，这表明虽然肺静脉在维持阵发性房颤中起作用，但这些结构对永久性房颤维持的独立贡献较小。
