Centurion O A, Isomoto S, Fukatani M, Shimizu A, Konoe A, Tanigawa M, Kaibara M, Sakamoto R, Hano O, Hirata T
Third Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Pacing Clin Electrophysiol. 1993 Oct;16(10):2022-33. doi: 10.1111/j.1540-8159.1993.tb00996.x.
The relationship between abnormal atrial electrograms (AAE) recorded during sinus rhythm by endocardial catheter mapping of the right atrium and the atrial conduction defects of sinus impulses or single atrial extrastimuli was investigated in 44 patients with sick sinus syndrome. The patients were divided into two groups on the basis of the presence (n = 29) or absence (n = 15) of AAE recorded during sinus rhythm. The P wave duration in the AAE (+) Group patients was 137 +/- 14 msec, and 125 +/- 15 msec in the AAE (-) Group; P < 0.02. The intraatrial conduction time of sinus impulses in the AAE (+) Group was 54 +/- 12 msec, and 39 +/- 9 msec in the AAE (-) Group; P < 0.001. The interatrial conduction time in the AAE (+) Group was 101 +/- 14 msec, and 78 +/- 16 msec in the AAE (-) Group; P < 0.001. In the AAE (+) Group, 11 (38%) patients had a sinus node recovery time > 4 seconds, whereas in the AAE (-) Group there was only one (6%) patient; P < 0.03. AAE showed a specificity of 93% and a positive predictive accuracy of 91% in predicting inducibility of atrial fibrillation. The sensitivity was 35% and the negative predictive accuracy was 42%. Sustained atrial fibrillation was induced in ten (35%) patients of the AAE (+) Group, and in one (7%) patient of the AAE (-) Group; P < 0.05. These data suggest that in patients with sick sinus syndrome who possess abnormal endocardial electrograms in sinus rhythm within the right atrium have: (1) a significantly longer P wave duration; (2) a significantly longer intraatrial and interatrial conduction time of sinus impulses; and (3) a significantly greater sinus node dysfunction and higher incidence of induction of sustained atrial fibrillation. It is concluded that there are significantly greater atrial conduction defects in patients with sick sinus syndrome who possess AAE within the right atrium during sinus rhythm.
在44例病态窦房结综合征患者中，研究了通过右心房心内膜导管标测在窦性心律期间记录的异常心房电图（AAE）与窦性冲动或单个心房期外刺激的心房传导缺陷之间的关系。根据窦性心律期间是否记录到AAE，将患者分为两组，存在AAE组（n = 29）和不存在AAE组（n = 15）。AAE（+）组患者的P波时限为137±14毫秒，AAE（-）组为125±15毫秒；P<0.02。AAE（+）组窦性冲动心房内传导时间为54±12毫秒，AAE（-）组为39±9毫秒；P<0.001。AAE（+）组房间传导时间为101±14毫秒，AAE（-）组为78±16毫秒；P<0.001。在AAE（+）组中，11例（38%）患者的窦房结恢复时间>4秒，而在AAE（-）组中只有1例（6%）患者；P<0.03。AAE在预测心房颤动的可诱导性方面显示出93%的特异性和91%的阳性预测准确性。敏感性为35%，阴性预测准确性为42%。AAE（+）组10例（35%）患者诱发了持续性心房颤动，AAE（-）组1例（7%）患者诱发了持续性心房颤动；P<0.05。这些数据表明，在病态窦房结综合征患者中，右心房在窦性心律时存在异常心内膜电图者具有：（1）明显更长的P波时限；（2）窦性冲动心房内和房间传导时间明显更长；（3）明显更严重的窦房结功能障碍和更高的持续性心房颤动诱发率。结论是，在窦性心律期间右心房存在AAE的病态窦房结综合征患者存在明显更严重的心房传导缺陷。
