Stiles Martin K, John Bobby, Wong Christopher X, Kuklik Pawel, Brooks Anthony G, Lau Dennis H, Dimitri Hany, Roberts-Thomson Kurt C, Wilson Lauren, De Sciscio Paolo, Young Glenn D, Sanders Prashanthan
Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
J Am Coll Cardiol. 2009 Apr 7;53(14):1182-91. doi: 10.1016/j.jacc.2008.11.054.
The purpose of this study was to determine whether patients with paroxysmal "lone" atrial fibrillation (AF) have an abnormal atrial substrate.
While "AF begets AF," prompt termination to prevent electrical remodeling does not prevent disease progression.
Twenty-five patients with paroxysmal lone AF, without arrhythmia in the week prior, and 25 reference patients with left-sided accessory pathways were studied. Multipolar catheters placed at the lateral right atrium (RA), crista terminalis, coronary sinus, septal RA, and sequentially within the left atrium (LA) determined the effective refractory period (ERP) at 10 sites, conduction time along linear catheters, and conduction characteristics at the crista terminalis. Bi-atrial electroanatomic maps were created to determine regional differences in conduction velocity and voltage.
Patients with AF demonstrated the following compared with reference patients: larger atrial volumes (RA: 94 +/- 18 ml vs. 69 +/- 9 ml, p = 0.003; LA: 99 +/- 19 ml vs. 77 +/- 17 ml, p = 0.006); longer ERP (at 600 ms: 255 +/- 25 ms vs. 222 +/- 16 ms, p < 0.001; at 450 ms: 234 +/- 20 ms vs. 212 +/- 14 ms, p = 0.004); longer conduction time along linear catheters (57 +/- 18 ms vs. 47 +/- 10 ms, p = 0.01); longer bi-atrial activation time (128 +/- 17 ms vs. 89 +/- 10 ms, p < 0.001); slower conduction velocity (RA: 1.3 +/- 0.3 mm/ms vs. 2.1 +/- 0.5 mm/ms; LA: 1.2 +/- 0.2 mm/ms vs. 2.2 +/- 0.4 mm/ms, p < 0.001); greater proportion of fractionated electrograms (27 +/- 8% vs. 8 +/- 5%, p < 0.001); longer corrected sinus node recovery time (265 +/- 57 ms vs. 185 +/- 60 ms, p = 0.002); and lower voltage (RA: 1.7 +/- 0.4 mV vs. 2.9 +/- 0.4 mV; LA: 1.7 +/- 0.7 mV vs. 3.3 +/- 0.7 mV, p < 0.001).
Patients with paroxysmal lone AF, remote from arrhythmia, demonstrate bi-atrial abnormalities characterized by structural change, conduction abnormalities, and sinus node dysfunction. These factors are likely contributors to the "second factor" that predisposes to the development and progression of AF.
本研究旨在确定阵发性“孤立性”心房颤动（AF）患者是否存在异常心房基质。
虽然“房颤引发房颤”，但迅速终止以防止电重构并不能阻止疾病进展。
研究了25例阵发性孤立性AF患者，这些患者在之前一周内无心律失常，以及25例左侧旁路参考患者。将多极导管置于右心房外侧（RA）、终末嵴、冠状窦、房间隔RA，并依次置于左心房（LA）内，测定10个部位的有效不应期（ERP）、沿线性导管的传导时间以及终末嵴的传导特性。创建双心房电解剖图以确定传导速度和电压的区域差异。
与参考患者相比，AF患者表现出以下情况：心房容积更大（右心房：94±18ml对69±9ml，p = 0.003；左心房：99±19ml对77±17ml，p = 0.006）；ERP更长（在600ms时：255±25ms对222±16ms，p<0.001；在450ms时：234±20ms对212±14ms，p = 0.004）；沿线性导管的传导时间更长（57±18ms对47±10ms，p = 0.01）；双心房激活时间更长（128±17ms对89±10ms，p<0.001）；传导速度更慢（右心房：1.3±0.3mm/ms对2.1±0.5mm/ms；左心房：1.2±0.2mm/ms对2.2±0.4mm/ms，p<0.001）；碎裂电图比例更高（27±8%对8±5%，p<0.001）；校正窦房结恢复时间更长（265±57ms对185±60ms，p = 0.002）；电压更低（右心房：1.7±0.4mV对2.9±0.4mV；左心房：1.7±0.7mV对3.3±0.7mV，p<0.001）。
阵发性孤立性AF患者，在远离心律失常时，表现出以结构改变、传导异常和窦房结功能障碍为特征的双心房异常。这些因素可能是导致AF发生和进展的“第二因素”。
