Gaita F, Giustetto C, Riccardi R, Mangiardi L, Brusca A
Istituto di Medicina e Chirurgia Cardiovascolare, Università di Torino.
G Ital Cardiol. 1990 Feb;20(2):109-13.
The purpose of this study was to examine the relation between spontaneous atrial fibrillation and the induction of atrial tachyarrhythmias during electrophysiologic study in patients with Wolff-Parkinson-White, with and without atrial fibrillation. Intracavitary electrophysiologic study was performed on 115 patients, 27 with spontaneous atrial fibrillation (group 1), 57 symptomatic due to AV re-entrant tachycardias, without spontaneous atrial fibrillation (group 2) and 31 asymptomatic (group 3). Induction of atrial fibrillation was attempted by using single and double atrial extrastimuli during atrial pacing at 2 different cycle lengths and by incremental atrial pacing (protocol A). When atrial fibrillation was not obtained, atrial bursts were added (protocol B). Atrial fibrillation or flutter were induced in 81% of group 1.54% of group 2 and 55% of group 3 patients (p less than 0.05), using protocol A. They were induced in 100, 75 and 71%, respectively (p = 0.01), with protocol B. Considering only sustained (greater than 1 minute) episodes, atrial fibrillation or flutter were induced in the three groups with protocol A in 74, 33 and 32% of the patients, respectively (p less than 0.001). The difference in the three groups was even greater when atrial fibrillation was considered separately from atrial flutter. The reason for this was that atrial fibrillation was induced in two thirds of group 1 patients, while only about 15% of patients without spontaneous atrial fibrillation had this arrhythmia induced. Our results suggest that the induction of sustained atrial fibrillation is a useful parameter to separate Wolff-Parkinson-White patients with from those without spontaneous atrial fibrillation. Due to the low specificity of the analysis of the shortest R-R interval during induced atrial fibrillation for the identification of the patients at risk of sudden death, the induction of sustained atrial fibrillation could be proposed as an additional parameter. This would improve the specificity of electrophysiologic study.
本研究旨在探讨预激综合征患者在有或无房颤情况下，电生理检查时自发性房颤与房性快速心律失常诱发之间的关系。对115例患者进行了心腔内电生理检查，其中27例有自发性房颤（第1组），57例因房室折返性心动过速有症状但无自发性房颤（第2组），31例无症状（第3组）。在2种不同周期长度的心房起搏时，通过使用单和双心房期外刺激以及递增性心房起搏（方案A）来尝试诱发房颤。当未诱发出房颤时，增加心房猝发刺激（方案B）。使用方案A时，第1组81%、第2组54%和第3组55%的患者诱发出房颤或房扑（p<0.05）。使用方案B时，分别为100%、75%和71%（p = 0.01）。仅考虑持续（大于1分钟）发作时，方案A在三组中分别有74%、33%和32%的患者诱发出房颤或房扑（p<0.001）。当将房颤与房扑分开考虑时，三组之间的差异更大。原因是第1组三分之二的患者诱发出房颤，而无自发性房颤的患者中只有约15%诱发出这种心律失常。我们的结果表明，持续性房颤的诱发是区分有和无自发性房颤的预激综合征患者的一个有用参数。由于诱发房颤时最短R-R间期分析对识别猝死风险患者的特异性较低，持续性房颤的诱发可作为一个附加参数提出。这将提高电生理检查的特异性。
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