Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan.
Heart Rhythm. 2010 May;7(5):577-83. doi: 10.1016/j.hrthm.2010.01.008. Epub 2010 Jan 11.
There is evidence that verapamil promotes the persistence of paroxysmal atrial fibrillation (AF). Little is known about the underlying mechanisms.
The purpose of this study was to determine the effect of verapamil on dominant frequencies (DFs) in the pulmonary veins (PVs) and atria during paroxysmal AF with reference to its potential arrhythmogenicity.
Forty-three patients with paroxysmal AF were studied. Bipolar electrograms were recorded simultaneously during AF from the right atrial free wall (RAFW), coronary sinus (CS) and three PVs, or two PVs and the left atrial appendage (LAA). The DFs were obtained by fast Fourier transform analysis before and after infusion of verapamil (0.1 mg/kg, intravenously).
At baseline, the maximum DF among the PVs (6.9 +/- 0.9 Hz) was significantly higher than the DF in the RAFW (6.2 +/- 0.7 Hz), CS (5.7 +/- 0.5 Hz), or LAA (5.9 +/- 0.7 Hz) (P<.01); there was a substantial PV-to-atrial DF gradient (RAFW 0.7 +/- 0.9, CS 1.1 +/- 0.7, LAA 0.7 +/- 0.9 Hz). Verapamil increased the atrial DF to 6.9 +/- 0.8, 6.6 +/- 0.7, and 7.2 +/- 1.0 Hz in the RAFW, CS, and LAA, respectively (P<.0001) but did not affect the maximum PV DF (7.1 +/- 0.7 Hz). The PV-to-atrial DF gradient was eliminated after verapamil (RAFW 0.2 +/- 0.8, CS 0.5 +/- 0.6, LAA -0.4 +/- 0.8 Hz; P<.01 vs. baseline).
Verapamil increases the activation frequency in the atria but not in the PVs, eliminating the PV-to-atrial DF gradient during paroxysmal AF.
有证据表明维拉帕米可促进阵发性心房颤动（AF）的持续存在。但其潜在的致心律失常机制知之甚少。
本研究旨在探讨维拉帕米对阵发性 AF 时肺静脉（PVs）和心房优势频率（DFs）的影响，并评估其潜在的致心律失常作用。
共纳入 43 例阵发性 AF 患者。在静脉注射维拉帕米（0.1mg/kg）前后，同步记录右心房游离壁（RAFW）、冠状窦（CS）和 3 个 PV 或 2 个 PV 和左心耳（LAA）的双极电图。采用快速傅里叶变换分析获得 DF。
基线时，PVs 的最大 DF（6.9±0.9Hz）明显高于 RAFW（6.2±0.7Hz）、CS（5.7±0.5Hz）和 LAA（5.9±0.7Hz）（P<.01）；存在显著的 PV-心房 DF 梯度（RAFW 0.7±0.9、CS 1.1±0.7、LAA 0.7±0.9Hz）。维拉帕米使 RAFW、CS 和 LAA 的心房 DF 分别增加至 6.9±0.8、6.6±0.7 和 7.2±1.0Hz（P<.0001），但不影响 PVs 的最大 DF（7.1±0.7Hz）。维拉帕米后，PV-心房 DF 梯度消失（RAFW 0.2±0.8、CS 0.5±0.6、LAA -0.4±0.8Hz；P<.01 与基线相比）。
维拉帕米增加了心房的激活频率，但不增加 PVs 的激活频率，从而消除了阵发性 AF 时的 PV-心房 DF 梯度。
