Lim Han S, Willoughby Scott R, Schultz Carlee, Alasady Muayad, Rangnekar Geetanjali, Dang Jerry, Gan Cheryl, Lau Dennis H, Roberts-Thomson Kurt C, Young Glenn D, Worthley Matthew I, Sanders Prashanthan
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
JACC Clin Electrophysiol. 2015 Jun;1(3):210-217. doi: 10.1016/j.jacep.2015.03.011. Epub 2015 Apr 20.
This study sought to determine the differences between the prothrombotic properties and chamber characteristics in patients with lone atrial fibrillation (AF) and those with AF and comorbidities.
Thromboembolic risk is increased in patients with AF; however, whether this is due to AF per se or its comorbidities remains unclear.
A total of 87 patients undergoing ablation were prospectively recruited for the study, including 30 patients with lone AF, 30 patients with AF and comorbidities in sinus rhythm, and 27 patients with left-sided accessory pathways as controls. Blood samples were obtained from the left atrium (LA), right atrium (RA), and femoral vein (FV) after transseptal puncture. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric-dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay.
Platelet activation in the LA was significantly elevated compared to that in the FV in patients with lone AF and those with AF and comorbidities compared with that in the FV (p < 0.05 respectively). Thrombin generation was significantly elevated in the LA compared with RA in AF patients (p < 0.05). There were no significant differences in P-selectin, TAT, and sCD40L among the 3 groups. However, there was a significant stepwise increase in endothelial dysfunction measured by ADMA from controls to lone AF and then to patients with AF and comorbidities (p < 0.001 between the 2 groups).
Patients with lone AF and those with AF and comorbidities had a greater propensity for atrial thrombogenesis than controls. Prothrombotic risk is greatest in those with comorbid conditions, in whom enhanced thrombogenesis occurs predominantly through increase in endothelial dysfunction.
本研究旨在确定孤立性房颤（AF）患者与合并其他疾病的房颤患者在血栓形成前特性和心房特征方面的差异。
房颤患者的血栓栓塞风险增加；然而，这是由于房颤本身还是其合并症所致仍不清楚。
前瞻性招募了87例接受消融治疗的患者，包括30例孤立性房颤患者、30例合并其他疾病且处于窦性心律的房颤患者以及27例左侧旁路患者作为对照。经房间隔穿刺后，从左心房（LA）、右心房（RA）和股静脉（FV）采集血样。通过流式细胞术测量血小板活化（P-选择素）。使用酶联免疫吸附测定法测量凝血酶生成（凝血酶-抗凝血酶[TAT]复合物）、内皮功能障碍（不对称二甲基精氨酸[ADMA]）和血小板衍生炎症（可溶性CD40配体[sCD40L]）。
与FV相比，孤立性房颤患者以及合并其他疾病的房颤患者的LA中血小板活化显著升高（分别为p < 0.05）。房颤患者中，LA中的凝血酶生成与RA相比显著升高（p < 0.05）。3组之间P-选择素、TAT和sCD40L无显著差异。然而，通过ADMA测量的内皮功能障碍从对照组到孤立性房颤患者再到合并其他疾病的房颤患者有显著的逐步增加（两组之间p < 0.001）。
孤立性房颤患者以及合并其他疾病的房颤患者比对照组有更大的心房血栓形成倾向。合并症患者的血栓形成前风险最大，其中血栓形成增强主要通过内皮功能障碍增加而发生。
