Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
J Thorac Cardiovasc Surg. 2012 Aug;144(2):327-33. doi: 10.1016/j.jtcvs.2011.09.022. Epub 2011 Oct 19.
Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation+mitral valve disease or with lone atrial fibrillation and compared it with controls.
Left and right atrial appendages amputated during Maze III surgery for lone atrial fibrillation (n=85) or atrial fibrillation+mitral valve disease (n=26) were embedded in paraffin, sectioned, and stained with picrosirius red. Atria from 10 deceased patients without a cardiovascular history served as controls. A total of 1048 images (4-μm sections, 10-fold magnification, 4 images per appendage) were obtained and digitized. The percentage of fibrous tissue was calculated by quantitative morphometry.
Irrespective of the presence or absence of atrial fibrillation or mitral valve disease, more fibrous tissue was present in right atrial appendages than in left atrial appendages (12.7%±5.7% vs 8.2%±3.9%; P<.0001). The mean amount of fibrous tissue in the atria was significantly larger in patients with atrial fibrillation+mitral valve disease than in patients with lone AF and controls (13.6%±5.8%, 9.7%±3.2%, and 8.8%±2.4%, respectively; P<.01). No significant differences existed between patients with lone atrial fibrillation and patients without a cardiovascular history (controls).
Atria of patients with atrial fibrillation and mitral valve disease have more fibrosis than atria of patients with lone atrial fibrillation. However, patients with lone atrial fibrillation have an equal amount of atrial fibrosis compared with controls. These findings support the notion that fibrosis plays a more important role in the pathogenesis of atrial fibrillation secondary to mitral valve disease than in lone atrial fibrillation and potentially explains the relatively poor success of antiarrhythmic surgery in patients with mitral valve disease.
心房纤维化与心房颤动有关，但在二尖瓣疾病或孤立性心房颤动患者中可能存在差异。因此，我们研究了孤立性心房颤动+二尖瓣疾病或单纯心房颤动患者的心房纤维化，并与对照组进行了比较。
在单纯行迷宫 III 手术治疗的孤立性心房颤动患者（n=85）或合并心房颤动+二尖瓣疾病患者（n=26）的心脏手术中，从左、右心耳切取组织，石蜡包埋，行天狼星红苦味酸染色。另取 10 例无心血管病史的尸检患者心房组织作为对照组。共获得 1048 张图像（4-μm 切片，10 倍放大，每个心耳 4 张切片），并进行数字化处理。采用定量形态学方法计算纤维组织的百分比。
无论是否存在心房颤动或二尖瓣疾病，右心耳的纤维组织含量均高于左心耳（12.7%±5.7% vs 8.2%±3.9%；P<.0001）。合并二尖瓣疾病的心房颤动患者心房组织的平均纤维组织含量显著高于单纯心房颤动患者和对照组（13.6%±5.8%、9.7%±3.2%和 8.8%±2.4%；P<.01）。单纯心房颤动患者与无心血管病史患者（对照组）之间差异无统计学意义。
合并二尖瓣疾病的心房颤动患者心房纤维化程度高于单纯心房颤动患者，但单纯心房颤动患者心房纤维化程度与对照组相当。这些发现支持这样一种观点，即纤维化在二尖瓣疾病引起的心房颤动发病机制中比在孤立性心房颤动中发挥更重要的作用，这可能解释了抗心律失常手术在二尖瓣疾病患者中相对较差的成功率。
