冠状窦起搏：对体表和心内信号平均 P 波时间域参数的影响。

Coronary sinus pacing: Its influence on external and intraatrial signal-averaged P wave time domain parameters.

出版信息

Cardiol J. 2007;14(5):470-81.

Abstract

BACKGROUND

The coronary sinus (CS) was, for 10 years, the standard place for permanent atrial pacing, and the antiarrhythmic properties of CS pacing were described by Moss in the early 70's. These observations were confirmed during EP studies, although currently permanent CS pacing is infrequently applied. Signal averaged (SA) P wave analysis has established values for the examination of EP properties of atrial myocardium. The aim of our study was to estimate the effect of CS pacing on the signal-averaged P wave recorded from external and intraatrial leads.

METHODS

Recordings were performed in 24 patients during biatrial pacing system implantation. A surface SA-ECG was obtained from orthogonal leads, and intraatrial signals were recorded and processed separately from the right and left atrium at SR and CS pacing. We analyzed standard SA-ECG parameters (P/A wave duration, RMS20 and LAS5) and the presence of atrial late potentials (ALP-Pdur > 125 ms and RMS20 < 2.40 mV).

RESULTS AND CONCLUSIONS

Coronary sinus pacing favourably modifies SA P wave parameters of the left atrium; it significantly shortens Pdur, distinctly increases RMS20, decreases LAS5 and eliminates ALP in most patients in comparison to SR. It indicates beneficial effects of CS pacing on left atrial excitation and may explain its antiarrhythmic effect. Coronary sinus pacing does not deteriorate right atrium activation; it even slightly increases RMS20 and shortens the duration of LAS5 in RA in comparison to SR. Our findings suggest that CS is still an attractive site for permanent atrial pacing in patients with atrial arrhythmias and atrial conduction disturbances. (Cardiol J 2007; 14: 470-481).

摘要

背景

10 年来，冠状窦（CS）一直是永久性心房起搏的标准部位，莫斯（Moss）在 70 年代早期描述了 CS 起搏的抗心律失常特性。尽管目前很少应用永久性 CS 起搏，但这些观察结果在电生理研究中得到了证实。信号平均（SA）P 波分析为研究心房心肌的电生理特性确立了标准。我们的研究目的是评估 CS 起搏对从外部和心内导联记录的信号平均 P 波的影响。

方法

在双心房起搏系统植入期间，对 24 例患者进行了记录。从正交导联获得体表 SA-ECG，分别从右心房和左心房在心房起搏时记录和处理心内信号。我们分析了标准 SA-ECG 参数（P/A 波持续时间、RMS20 和 LAS5）以及心房晚期电位（ALP-Pdur > 125ms 和 RMS20 < 2.40mV）的存在。

结果和结论

CS 起搏有利于改变左心房的 SA P 波参数；与 SR 相比，它明显缩短 Pdur，显著增加 RMS20，降低 LAS5，并消除大多数患者的 ALP。这表明 CS 起搏对左心房兴奋有有益的影响，可能解释其抗心律失常作用。CS 起搏不会加重右心房的激活；与 SR 相比，它甚至略微增加了 RA 的 RMS20，并缩短了 LAS5 的持续时间。我们的研究结果表明，CS 仍然是患有房性心律失常和房内传导障碍的患者进行永久性心房起搏的一个有吸引力的部位。（《心血管病杂志（英文版）》2007 年；14：470-481）