Cagli Kumral Ergun, Topaloglu Serkan, Aras Dursun, Sen Nihat, Akpinar Ibrahim, Durak Akif, Kisacik Halil Lutfi
Department of Cardiology, Türkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
J Interv Card Electrophysiol. 2009 Dec;26(3):217-24. doi: 10.1007/s10840-009-9438-z. Epub 2009 Oct 21.
The intrinsic atrial vulnerability is proposed as one of the mechanisms of paroxysmal atrial fibrillation (PAF) in Wolff-Parkinson-White (WPW) syndrome. In this study, we examined the early changes in atrial refractoriness and intra- and inter-atrial conduction times after radiofrequency (RF) catheter ablation of accessory pathway (AP).
Twenty-four consecutive patients with WPW syndrome and documented AV reciprocating tachycardia but without history of PAF (fourteen male, mean age 39 +/- 9.5 years) and 27 control subjects (six female, mean age 51.4 +/- 10.1 years) with AV nodal reentrant tachycardia (AVNRT) who underwent ablation of the slow AV nodal pathways were enrolled into the study. Regional atrial effective refractory periods (AERPs), AERP dispersion, and intra- and inter-atrial conduction times were obtained before and 30 min after ablation and were compared between two groups. In the study group, patients with and without inducible AF were also compared regarding these parameters.
In the study group, AERPs in higher right atrium and right posterolateral atrium were significantly increased, and AERP dispersion, intra-atrial, and inter-atrial conduction times were significantly decreased after ablation; AERP in distal coronary sinus was unchanged. In control group, no significant difference was observed in these parameters. Inducibility of AF was significantly reduced following ablation of AP in the study group (from seven to zero of 24 patients, p = 0.016). Comparison between patients with (n = 7) and without (n = 17) AF revealed that left atrium diameter was larger, AERPs in the right posterolateral atrium before and after ablation, and ERP of AP were shorter in AF group.
In WPW syndrome patients, RF catheter ablation of AP results in an 'immediate' decrease in atrial vulnerability. Since inducibility of AF becomes more difficult in this less vulnerable atrium, the AP itself may play an important role in the development of AF.
心房固有易损性被认为是预激综合征（WPW）患者阵发性心房颤动（PAF）的发病机制之一。在本研究中，我们观察了射频（RF）导管消融旁路（AP）后心房不应期以及房内和房间传导时间的早期变化。
连续纳入24例WPW综合征且有房室折返性心动过速记录但无PAF病史的患者（男性14例，平均年龄39±9.5岁），以及27例因房室结折返性心动过速（AVNRT）接受慢径消融的对照者（女性6例，平均年龄51.4±10.1岁）。在消融前及消融后30分钟测量局部心房有效不应期（AERP）、AERP离散度以及房内和房间传导时间，并在两组间进行比较。在研究组中，还比较了可诱发房颤和不可诱发房颤患者的这些参数。
研究组中，消融后右上心房和右后外侧心房的AERP显著增加，AERP离散度、房内和房间传导时间显著缩短；冠状静脉窦远端的AERP无变化。对照组这些参数无显著差异。研究组消融AP后房颤的诱发率显著降低（24例患者中从7例降至0例，p = 0.016）。有房颤（n = 7）和无房颤（n = 17）患者的比较显示，房颤组左心房直径更大，消融前后右后外侧心房的AERP以及AP的有效不应期更短。
在WPW综合征患者中，RF导管消融AP可使心房易损性“即刻”降低。由于在这个不易损的心房中诱发房颤变得更加困难，AP本身可能在房颤的发生中起重要作用。
