Department of Internal Medicine, Division of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan.
Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
J Cardiovasc Electrophysiol. 2020 Sep;31(9):2371-2379. doi: 10.1111/jce.14625. Epub 2020 Jun 29.
Pulmonary vein isolation (PVI) affects the ganglionated plexi (GP) around the atrium leading to a modification of intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has the potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in human remains unclear.
We analyzed electrocardiograms of 117 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent their first PVI procedures and maintained sinus rhythm without antiarrhythmic drugs at all evaluation points (4 h, 1 day, 1 month, and 3 months after PVI). Heart rate significantly increased at 4 h, 1 day, and 1 month. Raw QT interval prolonged at 4 h (417.1 ± 41.6 ms, p < .001) but shortened at 1 day (376.4 ± 34.1 ms, p < .001), 1 month (382.2 ± 31.5 ms, p < 0.001), and 3 months (385.1 ± 32.8 ms, p < 0.001) compared with baseline (391.6 ± 31.4 ms). Bazett-corrected QTc intervals were significantly prolonged at 4 h (430.8 ± 27.9 ms, p < .001), 1 day (434.8 ± 22.3 ms, p < .001), 1 month (434.8 ± 22.3 ms, p < .001), and 3 months (420.1 ± 21.8 ms, p < .001) compared with baseline (404.9 ± 25.2 ms). Framingham-corrected QTc intervals significantly prolonged at 4 h (424.1 ± 26.6 ms, p < .001) and 1 day (412.3 ± 29.3 ms, p < .01) compared with baseline (399.2 ± 22.7 ms). Multiple regression analysis revealed that female sex is a significant predictor of raw QT and QTc interval increase at 4 h after PVI.
Raw QT and QTc were prolonged after PVI, especially in the acute phase. Female sex is a risk factor for QT increase.
肺静脉隔离（PVI）会影响心房周围的神经节丛（GP），从而改变固有心脏自主神经系统（ANS）。在动物模型中，GP 消融有导致 QT 延长和室性心律失常的潜在风险。然而，PVI 对人类 QT 间期的影响尚不清楚。
我们分析了 117 例阵发性心房颤动（AF）患者的心电图，这些患者在所有评估点（PVI 后 4 小时、1 天、1 个月和 3 个月）均未服用抗心律失常药物而维持窦性心律。心率在 4 小时、1 天和 1 个月时显著增加。QT 间期在 4 小时时延长（417.1±41.6ms，p<0.001），但在 1 天（376.4±34.1ms，p<0.001）、1 个月（382.2±31.5ms，p<0.001）和 3 个月（385.1±32.8ms，p<0.001）时缩短，与基线（391.6±31.4ms）相比。Bazett 校正的 QTc 间期在 4 小时（430.8±27.9ms，p<0.001）、1 天（434.8±22.3ms，p<0.001）、1 个月（434.8±22.3ms，p<0.001）和 3 个月（420.1±21.8ms，p<0.001）时明显延长，与基线（404.9±25.2ms）相比。Framingham 校正的 QTc 间期在 4 小时（424.1±26.6ms，p<0.001）和 1 天（412.3±29.3ms，p<0.01）时明显延长，与基线（399.2±22.7ms）相比。多因素回归分析显示，女性是 PVI 后 4 小时 QT 间期和 QTc 间期延长的显著预测因素。
PVI 后 QT 和 QTc 间期延长，尤其是在急性期。女性是 QT 延长的危险因素。
