Sugiura T, Iwasaka T, Takahashi N, Yuasa F, Takeuchi M, Hasegawa T, Matsutani M, Inada M
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Am Heart J. 1991 May;121(5):1409-12. doi: 10.1016/0002-8703(91)90146-9.
To elucidate the role of inflammatory and hemodynamic factors in the genesis of atrial fibrillation in acute myocardial infarction, 228 patients with a first Q wave anterior myocardial infarction were studied. Forty-nine patients had pericarditis (detection of pericardial rub by careful auscultation), and 36 patients had echocardiographically demonstrated hydropericardium (presence of pericardial effusion without pericardial rub). During the first 3 days after admission, transient episodes of atrial fibrillation were observed in 10 patients (20%) with pericarditis (group 1), 15 patients (42%) with hydropericardium (group 2), and 20 patients (14%) without pericarditis and hydropericardium (group 3). Although there was no significant difference in the incidence of atrial fibrillation between groups 1 and 3, patients in group 2 had a significantly higher incidence of atrial fibrillation than those in groups 1 and 3. Pulmonary capillary wedge pressure and the number of advanced asynergic segments were found to be the important factors discriminating the three groups by multivariate analysis. Therefore atrial fibrillation after acute Q wave anterior infarction was not related to the inflammatory infiltration involving the atria but to the increase in atrial pressure resulting from hemodynamic change caused by more extensive myocardial damage.
为阐明炎症和血流动力学因素在急性心肌梗死并发心房颤动发生机制中的作用，对228例首次发生Q波型前壁心肌梗死的患者进行了研究。49例患者发生心包炎（通过仔细听诊发现心包摩擦音），36例患者经超声心动图证实有心包积液（存在心包积液但无心包摩擦音）。入院后的前3天，10例（20%）心包炎患者（第1组）、15例（42%）心包积液患者（第2组）和20例（14%）既无心包炎也无心包积液的患者（第3组）出现了短暂性心房颤动发作。虽然第1组和第3组之间心房颤动的发生率无显著差异，但第2组患者心房颤动的发生率显著高于第1组和第3组。多因素分析发现，肺毛细血管楔压和晚期运动失调节段的数量是区分这三组的重要因素。因此，急性Q波型前壁心肌梗死后的心房颤动与累及心房的炎症浸润无关，而是与更广泛心肌损伤导致的血流动力学改变引起的心房压力升高有关。
