Department of Cardiology, University of Medical Sciences, Poznań, Poland.
Department of Cardiology, Multidisciplinary District's Hospital, Nowa Sól, Poland.
J Cardiovasc Electrophysiol. 2018 Jan;29(1):22-29. doi: 10.1111/jce.13347. Epub 2017 Oct 11.
Muscular connections between the coronary sinus (CS) and left atrium probably impact distribution of electrical activity. Double atrial potentials (DP) may be their presentation. The aim was to investigate the presence of DP in CS recordings during atrioventricular reentrant tachycardia (AVRT) and its contribution to the occurrence of paroxysmal atrial fibrillation (AF).
A group of 247 patients with accessory pathways (AP) were screened for DP. The patients with DP during AVRT were compared to those without DP.
DP during AVRT were found only among the left-sided AP (AP-L). Patients with AP-L were divided into Group 1 (n = 17) with DP during AVRT and Group 2 (n = 108) without DP. Patients in Group 1 had higher incidence of AF in history (47.1% vs. 23.1%; P = 0.0376), AF induced during electrophysiological (EP) study (70.6% vs. 25%; P = 0.0002). Group 1 had higher heart rate (HR) during AVRT in the EP study (197.2 ± 27 vs. 175.1 ± 26.3 bpm; P = 0.0019), but HR of clinical AVRT (208.5 ± 30.8 vs. 191.6 ± 27.8 bpm) was not significant different (P = ns). Additionally, electrical alternans of QRS amplitude during AVRT in the EP study was more frequent in Group 1 (52.9 vs. 20.4 %; P = 0.0048).
Patients with DP and AP-L were more prone to develop AF. The presence of DP was associated with faster AVRT rate. The direction of atrium depolarization during AVRT may be different in the presence of DP and probably plays a role in development of AF in this group of patients.
冠状窦（CS）和左心房之间的肌肉连接可能会影响电活动的分布。双心房电位（DP）可能是其表现形式。本研究旨在探讨房室折返性心动过速（AVRT）期间 CS 记录中 DP 的存在及其对阵发性心房颤动（AF）发生的影响。
对 247 例旁路（AP）患者进行 DP 筛查。比较 AVRT 期间存在 DP 的患者和不存在 DP 的患者。
仅在左侧 AP（AP-L）中发现 AVRT 期间的 DP。AP-L 患者分为 1 组（n=17），AVRT 期间存在 DP，2 组（n=108），AVRT 期间不存在 DP。组 1 患者的 AF 发生率更高（47.1% vs. 23.1%；P=0.0376），电生理（EP）研究期间的 AF 发生率（70.6% vs. 25%；P=0.0002）。在 EP 研究中，组 1 的 AVRT 期间心率（HR）更高（197.2±27 vs. 175.1±26.3 bpm；P=0.0019），但临床 AVRT 的 HR（208.5±30.8 vs. 191.6±27.8 bpm）无显著差异（P=ns）。此外，EP 研究中 AVRT 期间 QRS 振幅的电交替在组 1 中更为常见（52.9% vs. 20.4%；P=0.0048）。
存在 DP 和 AP-L 的患者更易发生 AF。DP 的存在与 AVRT 更快的发生有关。AVRT 期间左心房去极化的方向可能在 DP 存在时有所不同，并且可能在这组患者中 AF 的发生中起作用。
