Calık Ali Nazmi, Ozcan Kazım Serhan, Cağdaş Metin, Güngör Barış, Karaca Gürkan, Gürkan Ufuk, Yılmaz Hale, Bolca Osman
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Sur gery Center, Istanbul, Turkey.
Cardiol J. 2014;21(2):138-43. doi: 10.5603/CJ.a2013.0106. Epub 2013 Aug 30.
Our main purpose in this study is to compare atrial (inter-atrial, intra-left atrial, intra-right atrial) electromechanical delays of patients with lone atrial fibrillation (LAF) with healthy individuals and examine the relationship of annual LAF attack frequency.
32 entirely healthy individuals and 32 patients who have presented with tachycardia and complying with LAF criteria have been included in the study. The time passing from the beginning of the P wave on electrocardiography to the A' wave on tissue Doppler trace was accepted as the atrial conduction time (PA'). The PA' time difference between the mitral annulus of left ventricle (ML) and the tricuspid annulus of right ventricle (TL) was defined as inter-atrial electromechanical delay (IA-EMD), the PA' time difference between the ML and septal mitral annulus (MS) as intra-left electromechanical delay (ILeft-EMD), the PA' time difference between MS and the TL as intra-right electromechanical delay (IRight-EMD).
ILeft-EMD (21.8 ± 9.1 vs. 14.1 ± 4.9, p < 0.001), IRight-EMD (9.3 ± 6.8 vs. 5.9 ± 4.9, p = 0.03) and IA-EMD times (24.7 ± 11.2 vs. 11.9 ± 7.1, p < 0.001) were significantly longer in LAF patients. In multivariate regression analysis, using a model including age, gender and left atrium (LA) volumes, ILeft-EMD times (OR 1.14, 95% CI 1.03-1.27,p = 0.012), IA-EMD times (OR 1.12, 95% CI 1.03-1.23, p = 0.007) and LA volumes (OR 1.18, 95% CI 1.05-1.32, p = 0.005) were independent predictors of LAF. In LAF group, the frequency of AF episodes was significantly correlated with ILeft-EMD (r = 0.90, p < 0.001) and IA-EMD times (r = 0.36, p < 0.004), whereas, IRight-EMD times and LA volumes were not correlated with recurrence rates.
ILeft-EMD and IA-EMD may increase in the early stages of atrial fibrillation even without the left atrial dilation and may be more valuable than left atrial area and volume in predicting atrial fibrillation.
本研究的主要目的是比较孤立性房颤（LAF）患者与健康个体的心房（心房间、左心室内、右心室内）机电延迟，并研究年度LAF发作频率之间的关系。
本研究纳入了32名完全健康的个体和32名出现心动过速且符合LAF标准的患者。心电图上P波开始至组织多普勒描记图上A'波的时间被视为心房传导时间（PA'）。左心室二尖瓣环（ML）与右心室三尖瓣环（TL）之间的PA'时间差被定义为心房间机电延迟（IA-EMD），ML与二尖瓣间隔环（MS）之间的PA'时间差为左心室内机电延迟（ILeft-EMD），MS与TL之间的PA'时间差为右心室内机电延迟（IRight-EMD）。
LAF患者的ILeft-EMD（21.8±9.1 vs. 14.1±4.9，p<0.001）、IRight-EMD（9.3±6.8 vs. 5.9±4.9，p = 0.03）和IA-EMD时间（24.7±11.2 vs. 11.9±7.1，p<0.001）明显更长。在多因素回归分析中，使用包含年龄、性别和左心房（LA）容积的模型，ILeft-EMD时间（OR 1.14，95%CI 1.03-1.27，p = 0.012）、IA-EMD时间（OR 1.12，95%CI 1.03-1.23，p = 0.007）和LA容积（OR 1.18，95%CI 1.05-1.32，p = 0.005）是LAF的独立预测因素。在LAF组中，房颤发作频率与ILeft-EMD（r = 0.90，p<0.001）和IA-EMD时间（r = 0.36，p<0.004）显著相关，而IRight-EMD时间和LA容积与复发率无关。
即使在无左心房扩张的情况下，房颤早期ILeft-EMD和IA-EMD可能增加，在预测房颤方面可能比左心房面积和容积更有价值。
