Giorgberidze I, Saksena S, Mongeon L, Mehra R, Krol R B, Munsif A N, Mathew P
J Interv Card Electrophysiol. 1997 Sep;1(2):111-23. doi: 10.1023/a:1009798914332.
Atypical atrial flutter has, hitherto, been relatively refractory to termination by rapid atrial pacing. High-frequency pacing (HFP) in the atrium, for termination of atrial flutter or atrial fibrillation (AF), and the electrophysiologic effects related to it have not been examined. We examined the clinical efficacy, safety, and electrophysiologic mechanisms of HFP using 50-Hz bursts at 10 mA applied at the high right atrium in patients with atypical atrial flutter (group 1) or AF (group 2), using a prospective randomized study protocol. Four burst durations (500, 1000, 2000, and 4000 ms) were applied at the high right atrium repetitively in random sequence in 22 patients with spontaneous atrial flutter or AF. Local and distant right and left atrial electrogram recordings were analyzed during and after HFP. HFP resulted in local and distant right and left atrial electrogram acceleration in 8 of 10 patients (80%) in group 1 but caused less frequent local atrial electrogram acceleration (6 of 12 patients) and no distant atrial electrogram effects in group 2 (p < .05 versus group 1). The HFP protocol was effective in arrhythmia termination in 6 of 10 patients in group 1 but in no patient in group 2 (p < .05 versus group 1). Standard HFP protocol applied at the high right atrium can frequently alter atrial activation in both atria and can terminate atypical atrial flutter. Efficacy in AF is limited, probably due to limited electrophysiologic actions beyond the local pacing site.
迄今为止，非典型心房扑动相对难以通过快速心房起搏终止。心房高频起搏（HFP）用于终止心房扑动或心房颤动（AF）及其相关的电生理效应尚未得到研究。我们采用前瞻性随机研究方案，对非典型心房扑动患者（第1组）或AF患者（第2组）在高位右心房施加10 mA的50 Hz猝发刺激，以研究HFP的临床疗效、安全性和电生理机制。对22例自发性心房扑动或AF患者，在高位右心房以随机顺序重复施加四种猝发持续时间（500、1000、2000和4000 ms）。在HFP期间和之后分析局部和远处右心房及左心房的电图记录。HFP使第1组10例患者中的8例（80%）出现局部和远处右心房及左心房电图加速，但第2组中局部心房电图加速的频率较低（12例患者中的6例），且对远处心房电图无影响（与第1组相比，p < 0.05）。HFP方案使第1组10例患者中的6例心律失常终止有效，但第2组无1例有效（与第1组相比，p < 0.05）。在高位右心房应用标准HFP方案可频繁改变双心房的心房激动，并可终止非典型心房扑动。对AF的疗效有限，可能是由于起搏部位以外的电生理作用有限。
