摘要
目的应用单相动作电位和电生理检查探讨慢性心房颤动(CAF)转复后右心房的电生理特征。方法21例无心房颤动病史的病人作为正常对照,37例心房颤动病人分为两组,阵发性心房颤动(PAF)10例,CAF27例,在窦性心律和基础起搏周长分别为600、500、400ms下记录并测定右心房7个位点的MAPD90,同时测定相应部位的心房有效不应期(ERP)。结果①各位点测定的ERP与MAPD90之间呈线形正相关(r=0.96,P<0.001),且满足ERP/MAPD90<1;②三组之间的maxMAPD90、maxERP均无明显差别(P>0.05);③CAF组avMAPD90和avERP均短于PAF组和对照组(P<0.05),而PAF组与对照之间比较无明显差别(P>0.05);④PAF和CAF组的minERP和minMAPD90均较对照组短(P<0.05和P<0.01),且CAF组短于PAF组(P<0.05);⑤CAF组和PAF组的dispMAPD90、dispERP均较对照组小(P<0.05和P<0.01),且CAF组小于PAF组(P<0.05);⑥对照组和PAF组在右心耳所测得的MAPD90和ERP最长,而CAF组则不定,且在此部位所测得的aveMAPD90和aveERP,明显短于PAF和对照组(P<0.05和P<0.01);⑦对照组和PAF组随着基础起搏周长增加,其MAPD90和ERP均明显延长(P<0.05),而CAF组,不同基础起搏周长下所测得的MAPD90和ERP均无明显变化(P>0.05)。结论MAPD90是一个较为可靠的指标,和心房ERP之间有较好的相关性。CAF发生了电重构,从而使心房颤动更容易维持,且经转复后更容易复发。
Objective To study the changes in atrial, electrophysiology associated with chronic persistent atrial fibrillation. Method Monophasic action potentials （MAPs） from the atrial, myocardium were studied in 10 patients with paroxysmal AF （PAF）, 27 patients with chronic persistent atrial fibrillation （CAF） after cardioversion and 21 control, individuals. The MAPs were recorded during sinus rhythm and continuous pacing at 7 sites of right atrium with pacing cycle lengths of 600, 500 and 400 ms. The effective refractory period （ERP） were measured at the same time. The MAPD90 was measured from onset to 90% of MAP repol.arization. Average, maximal., minimal. MAPD90 and ERP （avMAPD90, maxMAPD90, minMAPD90, avERP, maxERP, minERP） were obtained from all participants. The dispersion of MAPD90 （dispMAPD90） was defined as the difference between maxMAPD90 and minMAPD90, so as the dispERP. Result （1）Linear regression analysis showed a direct relationship between the MAP90 and ERP changes induced by different pacing cycle lengths （r =0.96,P〈0.01）. The ERP/MAP90 ratio was always 〈 1. （2） The maxMAPD90 and maxERP did not significantly differ among the 3 groups. （3） The avMAPD90 and avERP of CAF group were significantly shorter than those of PAF group and control.s, but no significant difference between PAF group and controls. （4） The minMAPD90 and minERP in the PAF and CAF group were significantly smaller than those in the control group, while the minMAPD90 and minERP in CAF group were smaller than those in PAF group. （5） The dispMAPD90 and dispERP were significantly longer in the PAF and CAF group than in the control group, and these in CAF group were longer than those in PAF group. （6） In control and PAF group, the ERP was significantly longer at the atrial appendage than at the lateral wall, but this was not observed in CAF patients. Furthermore, the MAPD90 and ERP measured at this site in CAF group were significantly smaller than those of PAF patients and controls. （7）
出处
《热带医学杂志》
CAS
2006年第12期1268-1270,1239,共4页
Journal of Tropical Medicine
基金
深圳市科技局基金(No.418#)
关键词
心房颤动
单相动作电位
有效不应期
电生理
atrial fibrillation
monophasic action potential
effective refractory period
electrophysiology
