Confino Jason, Edmundowicz Daniel, Lacomis Joan M, Ocak Iclal, Deible Christopher R, Schwartzman David
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
J Atr Fibrillation. 2008 Dec 1;1(4):107. doi: 10.4022/jafib.107. eCollection 2008 Dec.
Lone atrial fibrillation (LAF) is considered by some to be a primary atrial electrophysiologic disorder. However, we have frequently observed evidence of "extraatrial" diseases - atherosclerosis and associated metabolic disorders - in our LAF patients. We sought to characterize and quantify extraatrial disease burden in LAF patients, and to correlate this burden with features of the arrhythmia including pattern (paroxysmal versus persistent) and response to catheter ablation.
Forty-six consecutive patients with non-familial LAF underwent assessment for evidence of atherosclerosis (computed tomographic vascular calcification and elevated arterial pulse wave velocity) and associated metabolic diseases (dyslipidemia, insulin resistance and inflammation), and then catheter ablation. The cohort had a significant incidence of atherosclerosis (57%) and metabolic (70%) diseases. Patients with persistent AF tended to have a greater extraatrial disease burden than those with paroxysmal AF. A significant inverse relationship between the rate of ablation success and extraatrial disease burden was demonstrated.
Extraatrial disease was common in this LAF cohort. Correlations between extraatrial disease burden and features of the arrhythmia would, if verified, challenge the notion that LAF is a "primary" electrophysiologic disorder.
一些人认为孤立性房颤（LAF）是一种原发性心房电生理紊乱。然而，我们在LAF患者中经常观察到“心房外”疾病的证据——动脉粥样硬化及相关代谢紊乱。我们试图对LAF患者的心房外疾病负担进行特征描述和量化，并将这种负担与心律失常的特征（包括类型，阵发性与持续性）以及导管消融反应相关联。
46例连续性非家族性LAF患者接受了动脉粥样硬化（计算机断层扫描血管钙化和动脉脉搏波速度升高）及相关代谢疾病（血脂异常、胰岛素抵抗和炎症）的评估，随后接受导管消融。该队列中动脉粥样硬化（57%）和代谢疾病（70%）的发生率很高。持续性房颤患者往往比阵发性房颤患者有更大的心房外疾病负担。消融成功率与心房外疾病负担之间存在显著的负相关。
心房外疾病在该LAF队列中很常见。如果得到证实，心房外疾病负担与心律失常特征之间的相关性将挑战LAF是一种“原发性”电生理紊乱的观念。
