Waxman M B, Yao L, Cameron D A, Kirsh J A
Department of Medicine, University of Toronto, Ontario, Canada.
J Am Coll Cardiol. 1991 Jun;17(7):1545-52. doi: 10.1016/0735-1097(91)90645-p.
The effects of passive upright tilting from 0 degrees to +60 degrees (n = 27), Valsalva maneuver (n = 16) and respiration (n = 10) on the rate of atrial flutter were studied in 27 patients. After tilting to +60 degrees, the atrial flutter cycle length shortened in all patients from 247.5 +/- 7 to 236.7 +/- 6.9 ms (range of shortening 1 to 21 ms, p less than 0.001). The Valsalva maneuver (strain of 40 mm Hg) shortened the flutter cycle length during the strain (phase 2) from 242.2 +/- 4.6 to 230.5 +/- 5 ms (range of shortening 2 to 19 ms, p less than 0.001). In 10 patients whose respiration was monitored, the flutter cycle length consistently prolonged during inspiration and shortened during expiration. Combined beta-adrenergic and muscarinic receptor blockade in six patients did not significantly alter the flutter cycle length at rest or the effects of the various maneuvers on the changes in flutter cycle length. This study revealed that the atrial flutter cycle length can be shortened by passive upright tilting, the strain phase of the Valsalva maneuver and expiration. Changes in flutter cycle length were independent of autonomic tone, implying that by decreasing cardiac volume, these maneuvers affect characteristics of the atrial flutter circuit, thereby producing dynamic changes in the rate of atrial flutter.
对27例患者研究了从0度被动直立倾斜至+60度（n = 27）、瓦尔萨尔瓦动作（n = 16）和呼吸（n = 10）对心房扑动频率的影响。倾斜至+60度后，所有患者的心房扑动周期长度均缩短，从247.5±7毫秒缩短至236.7±6.9毫秒（缩短范围为1至21毫秒，p<0.001）。瓦尔萨尔瓦动作（40毫米汞柱的压力）使用力阶段（第2阶段）的扑动周期长度从242.2±4.6毫秒缩短至230.5±5毫秒（缩短范围为2至19毫秒，p<0.001）。在监测呼吸的10例患者中，扑动周期长度在吸气时持续延长，在呼气时缩短。对6例患者联合使用β-肾上腺素能和毒蕈碱受体阻滞剂，并未显著改变静息时的扑动周期长度，也未改变各种动作对扑动周期长度变化的影响。本研究显示，被动直立倾斜、瓦尔萨尔瓦动作的用力阶段和呼气可使心房扑动周期长度缩短。扑动周期长度的变化与自主神经张力无关，这意味着通过减少心脏容量，这些动作会影响心房扑动环路的特征，从而使心房扑动频率产生动态变化。
