Nagahama Y, Sugiura T, Takehana K, Hatada K, Inada M, Iwasaka T
Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
Eur Heart J. 1998 Feb;19(2):287-92. doi: 10.1053/euhj.1997.0744.
Transient atrial fibrillation is a relatively common arrhythmia in the early phase of acute Q-wave myocardial infarction. However, the role of infarction-associated pericarditis on the genesis of atrial fibrillation is controversial. This study was designed to examine the relative importance of infarction-associated pericarditis among other clinical variables on the genesis of transient atrial fibrillation in patients with acute myocardial infarction.
Three hundred and ninety-eight patients with acute Q-wave myocardial infarction were examined carefully by means of auscultation, ECG, two-dimensional echocardiography and haemodynamic measurements. The diagnosis of pericarditis was made on the basis of pericardial rub detected during the first 3 days after admission. At least 0.5 mm of PQ-segment depression from a TP segment lasting more than 24 h in both limb and precordial leads was considered diagnostic of PQ-segment depression. Atrial fibrillation was present in 76 patients (19%). Sixteen (42%) of 38 patients with PQ-segment depression had atrial fibrillation, whereas 23 (30%) of 77 patients with pericardial rub had atrial fibrillation. Based on ten clinical variables, multivariate analysis was performed to determine the important variables related to the occurrence of atrial fibrillation. PQ-segment depression (chi-square = 4.10, P < 0.05) was selected with age (chi-square = 10.52, P < 0.005), the number of left ventricular segments with advanced asynergy (chi-square = 7.73, P < 0.01) and pericardial effusion (chi-square = 7.95, P < 0.005) as important factors related to atrial fibrillation. Patients with PQ-segment depression had a significantly higher pulmonary capillary wedge pressure than those without it.
Among patients with infarction-associated pericarditis, those with PQ-segment depression represent atrial involvement associated with extensive myocardial damage and hence, PQ-segment depression is one of the clinical signs related to the occurrence of atrial fibrillation in acute Q-wave myocardial infarction.
短暂性心房颤动是急性Q波心肌梗死早期相对常见的心律失常。然而，梗死相关心包炎在心房颤动发生中的作用存在争议。本研究旨在探讨梗死相关心包炎在急性心肌梗死患者短暂性心房颤动发生的其他临床变量中的相对重要性。
对398例急性Q波心肌梗死患者进行仔细听诊、心电图、二维超声心动图和血流动力学测量。心包炎的诊断基于入院后前3天检测到的心包摩擦音。肢体导联和胸前导联中TP段PQ段压低至少0.5mm持续超过24小时被认为是PQ段压低的诊断标准。76例患者（19%）出现心房颤动。38例PQ段压低患者中有16例（42%）发生心房颤动，而77例有心包摩擦音的患者中有23例（30%）发生心房颤动。基于10个临床变量进行多因素分析以确定与心房颤动发生相关的重要变量。PQ段压低（卡方=4.10，P<0.05）与年龄（卡方=10.52，P<0.005）、左心室节段重度运动不协调数量（卡方=7.73，P<0.01）和心包积液（卡方=7.95，P<0.005）被选为与心房颤动相关的重要因素。PQ段压低患者的肺毛细血管楔压显著高于无PQ段压低的患者。
在梗死相关心包炎患者中，有PQ段压低的患者提示心房受累与广泛心肌损伤有关，因此，PQ段压低是急性Q波心肌梗死中心房颤动发生的临床征象之一。
