Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Europace. 2012 Nov;14(11):1560-6. doi: 10.1093/europace/eus180. Epub 2012 Jun 13.
Research on paroxysmal atrial fibrillation (AF) assumes that fibrillation induced by rapid pacing adequately reproduces spontaneously occurring paroxysmal AF in humans. We aimed to compare the spectral properties of spontaneous vs. induced AF episodes in paroxysmal AF patients.
Eighty-five paroxysmal AF patients arriving in sinus rhythm to the electrophysiology laboratory were evaluated prior to ablation. Atrial fibrillation was induced by rapid pacing from the pulmonary vein-left atrial junctions (PV-LAJ), the coronary sinus (CS), or the high right atrium (HRA). Simultaneous recordings were obtained using multipolar catheters. Off-line power spectral analysis of 5 s bipolar electrograms was used to determine dominant frequency (DF) at recording sites with regularity index >0.2. Sixty-eight episodes were analysed for DF. Comparisons were made between spontaneous (n = 23) and induced (n = 45) AF episodes at each recording site. No significant differences were observed between spontaneous and induced AF episodes in HRA (5.18 ± 0.69 vs. 5.06 ± 0.91 Hz; P = 0.64), CS (5.27 ± 0.69 vs. 5.36 ± 0.76 Hz; P = 0.69), or LA (5.72 ± 0.88 vs. 5.64 ± 0.75 Hz; P = 0.7) regardless of pacing site. Consistent with these results, paired analysis in seven patients with both spontaneous and induced AF episodes, showed no regional DFs differences. Moreover, a left-to-right DF gradient was also present in both spontaneous (PV-LAJ 5.71 ± 0.81 vs. HRA 5.18 ± 0.69 Hz; P = 0.005) and induced (PV-LAJ 5.62 ± 0.72 vs. HRA 5.07 ± 0.91 Hz; P = 0.002) AF episodes, with no differences between them (P = not specific).
In patients with paroxysmal AF, high-rate pacing-induced AF adequately mimics spontaneously initiated AF, regardless of induction site.
阵发性心房颤动（AF）的研究假设快速起搏诱发的颤动能充分再现人类自发性阵发性 AF。我们旨在比较阵发性 AF 患者自发与诱发性 AF 发作的频谱特性。
85 例阵发性 AF 患者在消融前到达电生理实验室的窦性节律。通过从肺静脉-左心房交界处（PV-LAJ）、冠状窦（CS）或高位右心房（HRA）进行快速起搏来诱发 AF。使用多极导管同时进行记录。使用离线双极电图 5s 的功率谱分析来确定规则指数>0.2 的记录部位的主导频率（DF）。对 68 个 DF 进行分析。在每个记录部位比较自发性（n=23）和诱发性（n=45）AF 发作。在 HRA（5.18±0.69 与 5.06±0.91 Hz；P=0.64）、CS（5.27±0.69 与 5.36±0.76 Hz；P=0.69）或 LA（5.72±0.88 与 5.64±0.75 Hz；P=0.7），自发性与诱发性 AF 发作之间均无显著差异，而与起搏部位无关。与这些结果一致的是，在 7 例同时存在自发性和诱发性 AF 发作的患者中进行配对分析，并未显示出区域性 DF 差异。此外，在自发性（PV-LAJ 5.71±0.81 与 HRA 5.18±0.69 Hz；P=0.005）和诱发性（PV-LAJ 5.62±0.72 与 HRA 5.07±0.91 Hz；P=0.002）AF 发作中也存在从左到右的 DF 梯度，且两者之间无差异（P=非特异性）。
在阵发性 AF 患者中，高心率起搏诱发的 AF 能充分模拟自发性发作的 AF，而与诱导部位无关。
