Keane D, Stafford P, Baker S, Lewis S, Jackson G, Vincent R
Cardiology Department, Guy's Hospital, London, United Kingdom.
Pacing Clin Electrophysiol. 1995 Jul;18(7):1346-53. doi: 10.1111/j.1540-8159.1995.tb02595.x.
The detection of paroxysmal atrial fibrillation (AF) in patients requiring a permanent pacemaker for sinus node disease may influence the choice of both pacemaker and programmed mode. While signal-averaged ECG of the P wave (SAEP) during sinus rhythm may detect patients with paroxysmal AF, the value of SAEP in the presence of sinus node disease is unknown. We therefore evaluated SAEP in patients with sinus node disease during sinus rhythm and atrial pacing. We investigated 10 patients with sinus node disease alone (SND), 10 with sinus node disease and paroxysmal AF (SND-PAF), and 20 normal controls (NC) using a P wave specific, signal-averaging system. In sinus rhythm, duration and energy were greater in SND-PAF than in SND and NC (mean [SEM] duration: 153 [4] msec, 140 [4] msec, and 134 [2] msec, P < 0.001; energy from 20-150 Hz: 76 [18] muV2.sec, 48 [7] muV2.sec, and 36 [3] muV2.sec, P = 0.006). Atrial pacing in SND-PAF produced an 11% prolongation of atrial activation but little further abnormality in P wave characteristics. In SND, atrial pacing caused a 20% prolongation of the P wave and increased P wave energy to a greater extent than in SND-PAF. We conclude that in patients with SND, atrial activation appears similar to normal controls during sinus rhythm but changes significantly on pacing. In patients with SND-PAF, atrial activation is abnormal during sinus rhythm with little further change when the atrium is paced. SAEP may be useful in detecting a predisposition to paroxysmal AF in the presence of sinus node disease and might help optimize pacemaker prescription.
对于因窦房结疾病而需要植入永久起搏器的患者，阵发性心房颤动（AF）的检测可能会影响起搏器及程控模式的选择。虽然窦性心律时P波信号平均心电图（SAEP）可检测出阵发性AF患者，但在存在窦房结疾病的情况下SAEP的价值尚不清楚。因此，我们评估了窦房结疾病患者在窦性心律及心房起搏时的SAEP。我们使用P波特异性信号平均系统对10例单纯窦房结疾病（SND）患者、10例窦房结疾病合并阵发性AF（SND-PAF）患者及20例正常对照（NC）进行了研究。在窦性心律时，SND-PAF组的P波时限和能量大于SND组及NC组（平均[标准误]时限：153[4]毫秒、140[4]毫秒和134[2]毫秒，P<0.001；20-150Hz能量：76[18]μV²·秒、48[7]μV²·秒和36[3]μV²·秒，P = 0.006）。SND-PAF组心房起搏使心房激动时间延长11%，但P波特征几乎无进一步异常。在SND组，心房起搏使P波时限延长20%，且P波能量增加幅度大于SND-PAF组。我们得出结论，SND患者在窦性心律时心房激动与正常对照相似，但起搏时显著改变。SND-PAF患者在窦性心律时心房激动异常，心房起搏时变化不大。SAEP可能有助于检测窦房结疾病患者发生阵发性AF的倾向，并可能有助于优化起搏器的处方。
