心房内二点起搏对诱发心房颤动的实验研究  

Experimental study on induced AF by using dual-site atrial pacing

作　　者：梁兆光[1] 姜玉萍[1] 谷宏越[1] 刘和平[1] 王桂照[1] 孟凡超[1] 黄永麟[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院,150001

出　　处：《中华心律失常学杂志》1998年第4期281-284,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨心房内二点起搏对诱发心房颤动(房颤)的抑制作用。方法健康杂种犬7只,麻醉状态下常规插管置入冠状静脉窦(CS)、右心室心尖部(RVa)、高位右心房(HRA)、希氏束(HBE)及 Koch 后三角(PTr)电极。程序刺激 HRA 和 CSd,直至房颤发生或到达心房有效不应期(ERP)。然后在 CSd、CSp 起搏,HRA 加早搏直到 HRA 有效不应期(ERP)或诱发房颤。再在 HRA 起搏,GSd、CSp 加早搏直到 CSd、CSp ERP 或诱发房颤。结果 HRA 程序刺激诱发房颤的早搏间期为85±22,36(70～100)ms。CSd 程序刺激未能诱发房颤。在 CSd 或 CSp 起搏,于 HRA 加心房早搏(PAC),在原来诱发房颤的早搏配对间期未见房颤诱发。有3只犬 CSd 起搏时的 HRA—ERP 明显长于 HRA 起搏、HRA—PAC 之 HRA-ERP(110±26.46 ms vs 76.67±5.77 ms,P<0.05),CSd 起搏时 HRA 提前进入有效不应期。继续递减刺激至原来诱发房颤的 S_1S_2间期,心房均不被激动,也未能诱发房颤。当 CSd 起搏时,HRA 最短的 AA 间期明显长于 HRA 起搏、HRA 早搏的 AA 间期(P<0.05),PTr 的 AA 间期也有所延长。HRA 起搏,分别于 CSd 和 CSp 加早搏时,以上3只犬的 CSd 和 CSp 心房肌有效不应期也有所延长。结论心房内起搏可明显抑制 HRA 早搏诱发的房颤发生率,且可能有延长心房有效不应期的作用。Objective To study whether a dual-site atrial pacing approach could suppress induced a- trial fibrillation(AF).Methods After the 7 mongrel dogs were anesthetized,routine electrophysiological catheter leads were respectively positioned at coronary sinus(CS),right ventricular apex(RVa),high right atrium(HRA),His bundle(HBE)and posterior triangle of Koch(PTr).Programmed electrical stimulation (PES)was performed from HRA and CSd until AF was induced or until the atrial ERP was encountered. Then single HRA PAC were delivered during CSd-or CSp-paced drives until the atrial ERP was reached or until AF was induced.Similarly,CSd or CSp PAC were delivered during HRA-paced drives until the CSd or CSp ERP was reached or until AF was induced.Results AF was induced after HRA-PES at a mean cou- pling interval of 85±22.36(70～100)ms.AF was not induced after CSd-PES at the critical HRA PAC coupling interval that previously induced AF during HRA pacing,AF was not induced during CSd or CSp pacing,The HRA-ERP of 3 dogs during CSd pacing was significantly louger than the one achieved during HRA-paced/HRA PAC(110±26.46 ms vs 76.67±5.77 ms,P<0.05),The HRA ERP was encountered earlier,At the critical HRA PAC coupling interval that previously induced AF during HRA pacing,the atri- um was not activated and AF was not induced.The shortest AA coupling interval at HRA was significantly longer than the one achieved during HRA-paced/HRA PAC(P<0.05).The AA coupling interval at PTr was also prolonged.The CSd-and CSp-ERP of previous 3 dogs were also prolonged during HRA-paced/CSd and CSp PAC.Conclusion The atrial pacing could significantly suppress the incidence of AF induced by HRA PAC and prolong atrial ERP.

关 键 词：心房 起搏 心房颤动 有效不应期 心脏病 

分 类 号：R541.75[医药卫生—心血管疾病]