心房颤动时的心房颤动率与左心房血栓形成风险

Atrial fibrillatory rate and risk of left atrial thrombus in atrial fibrillation.

作者信息

Bollmann Andreas, Husser Daniela, Stridh Martin, Holmqvist Fredrik, Roijer Anders, Meurling Carl J, Sörnmo Leif, Olsson S Bertil

机构信息

Department of Cardiology, Lund University Hospital, Lund, Sweden.

出版信息

Europace. 2007 Aug;9(8):621-6. doi: 10.1093/europace/eum125. Epub 2007 Jun 29.

DOI:10.1093/europace/eum125

PMID:17604306

Abstract

AIMS

In atrial fibrillation (AF), a relation between electrocardiogram (ECG) fibrillatory wave amplitude and thrombus formation has been sought for long with conflicting results. In contrast, the possible relation between atrial fibrillatory rate obtained from the surface ECG and left atrial thrombus formation in patients with AF is unknown and was consequently evaluated in this study.

METHODS AND RESULTS

One-hundred and twenty-five patients (mean age 64 +/- 12 years, 72% male) with persistent non-valvular AF (mean duration 28 +/- 80 days) undergoing transesophageal echocardiography were studied. In all patients, standard 12-lead ECG recordings were acquired before the examination. Atrial fibrillatory rate was determined using spatiotemporal QRST cancellation and time-frequency analysis of lead V1. Atrial fibrillatory rate measured 401 +/- 63 fibrillations per minute (fpm, range 235-566 fpm) and was related with age (R = -0.326, P < 0.001), ventricular rate (R = -0.202, P = 0.024), gender (407 +/- 62 in males vs. 387 +/- 64 fpm in females, P = 0.038) but not AF duration (R = 0.088, P = 0.374), presence of lone AF (408 +/- 66 vs. 394 +/- 58 fpm, P = 0.228), or beta-blocker or calcium channel blocker treatment (398 +/- 63 vs. 405 +/- 62 fpm, P = 0.556). Age was the only independent predictor of fibrillatory rate (B = -1.714, P < 0.001). In patients with left atrial thrombus (n = 10), spontaneous echo contrast (SEC) was more frequently present (70 vs. 29 %, p = 0.007) and left atrial appendage (LAA) outflow velocity was lower (26 +/- 20 vs. 37 +/- 15 cm/s, P = 0.012) than in patients without thrombus (n = 115). In contrast, mean fibrillatory rate, which showed a weak inverse correlation with LAA velocity (R = -0.118, P = 0.048) was not different between both groups (380 +/- 56 vs. 403 +/- 63 fpm, P = 0.226). Similarly, presence of thrombus and SEC combined was not related with fibrillatory rate.

CONCLUSION

Atrial fibrillatory rate obtained from surface ECG lead V1 is not a risk marker for left atrial thrombus formation in AF.

摘要

目的

长期以来一直在探寻心电图（ECG）颤动波振幅与心房颤动（AF）患者血栓形成之间的关系，但其结果相互矛盾。相比之下，体表心电图测得的心房颤动率与AF患者左心房血栓形成之间的可能关系尚不清楚，因此本研究对其进行了评估。

方法与结果

对125例持续性非瓣膜性AF（平均病程28±80天）患者（平均年龄64±12岁，72%为男性）进行经食管超声心动图检查。所有患者在检查前均进行标准12导联心电图记录。采用时空QRST消除法和V1导联的时频分析测定心房颤动率。测得的心房颤动率为每分钟401±63次颤动（fpm，范围235 - 566 fpm），与年龄（R = -0.326，P < 0.001）、心室率（R = -0.202，P = 0.024）、性别（男性为407±62 fpm，女性为387±64 fpm，P = 0.038）有关，但与AF病程（R = 0.088，P = 0.374）、孤立性AF的存在（408±66 vs. 394±58 fpm，P = 0.228）或β受体阻滞剂或钙通道阻滞剂治疗（398±63 vs. 405±62 fpm，P = 0.556）无关。年龄是心房颤动率的唯一独立预测因素（B = -1.714，P < 0.001）。在有左心房血栓的患者（n = 10）中，与无血栓的患者（n = 115）相比，自发显影（SEC）更常见（70%对29%，p = 0.007），左心耳（LAA）流出速度更低（26±20 vs. 37±15 cm/s，P = 0.012）。相比之下，两组之间平均颤动率无差异（380±56 vs. 403±63 fpm，P = 0.226），平均颤动率与LAA速度呈弱负相关（R = -0.118，P = 0.048）。同样，血栓和SEC同时存在与颤动率无关。