Petrutiu Simona, Sahakian Alan V, Swiryn Steven
Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, IL, USA.
Europace. 2007 Jul;9(7):466-70. doi: 10.1093/europace/eum096. Epub 2007 May 31.
We investigated the process of spontaneous termination of atrial fibrillation (AF) to determine its time course from the surface ECG.
We studied fibrillatory waves in Holter recordings of paroxysmal and sustained AF. Following QRS-T cancellation dominant frequencies (DFs) were computed and the relationship of DF to termination was scrutinized. For 57 episodes of paroxysmal AF (PAF) in 24 patients, DF ranged from 4.4 to 6.5 Hz (5.2 +/- 0.4 Hz) compared to 5.8 to 7.4 Hz (6.6 +/- 0.6 Hz) for sustained AF recordings. Comparison of the atrial frequency of the ultimate to the penultimate second demonstrated a drop in frequency in 51 of 57 episodes, P < 0.00001. No comparable change was seen at longer time periods. Moments of comparably low frequency without termination were only occasionally seen in patients with PAF but not in patients with sustained AF.
Low frequency fibrillation was found to be much more likely to terminate. Frequency changes preceding spontaneous termination were abrupt, in contrast to the gradual frequency drop reported with drug-induced termination. The analysis of fibrillatory wave characteristics and their change over time might be used to target specific moments for pacing therapy in patients with AF.
我们研究了房颤（AF）的自发终止过程，以确定其从体表心电图上的时间进程。
我们研究了阵发性和持续性房颤动态心电图记录中的颤动波。在消除QRS-T波后计算主导频率（DFs），并仔细研究DF与终止的关系。24例患者的57次阵发性房颤（PAF）发作中，DF范围为4.4至6.5Hz（5.2±0.4Hz），而持续性房颤记录的DF为5.8至7.4Hz（6.6±0.6Hz）。比较最后一秒与倒数第二秒的心房频率，57次发作中有51次频率下降，P<0.00001。在更长时间段内未观察到类似变化。在PAF患者中偶尔可见频率相当低但未终止的情况，而持续性房颤患者中未见。
发现低频颤动更有可能终止。与药物诱导终止时报道的频率逐渐下降相反，自发终止前的频率变化是突然的。对颤动波特征及其随时间变化的分析可用于确定房颤患者起搏治疗的特定时机。
