高血压对心房颤动患者电解剖特征的影响  

The impact of hypertension on the electroanatomical characteristics of patients with atrial fibrillation

作　　者：王涛[1] 夏云龙[1] 解泽宙[1] 林玉壁[1] 高连君[1] 张树龙[1] 杨延宗[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁116011

出　　处：《中华高血压杂志》2011年第7期647-651,共5页Chinese Journal of Hypertension

摘　　要：目的研究高血压对心房颤动(房颤)患者电解剖特征的影响。方法入选213名在我院心内科接受由CARTO系统引导的环肺静脉隔离术的房颤患者,其中持续性房颤患者77人,阵发性房颤于窦律下标测患者88人,阵发性房颤于房颤发作时标测患者48人。每组再按有无高血压分为高血压组和无高血压组,在CARTO指导下行环肺静脉电隔离。消融前标测得到电解剖图像,记录平均电压幅度,并进行组间比较。随访观察高血压对射频消融成功率的影响。结果阵发性房颤窦律标测组中无高血压组与高血压组相比,左心房平均双极电压更高(1.90比1.29mV,P<0.05),而低电压区的比例低(0.064比0.136,P<0.05)。阵发性房颤患者房颤标测组及持续性房颤患者中有无高血压的双极电压测定也有类似结果,即无高血压组双极电压更高(1.27比1.03mV,0.72比0.47mV;均P<0.05),低电压区比例低(0.101比0.129,0.545比0.687;均P<0.05)。消融后随访(6.5±2.3)月,各组房颤患者中无高血压组与高血压组射频消融成功率无明显差异(均P>0.05)。结论合并高血压的房颤患者显示更加明显的左心房电解剖特性改变,提示高血压可以导致房颤基质改变,进而参与房颤的发生及维持。但是这些改变仍未显示出对房颤消融结果的影响,其具体的机制和原因仍需进一步研究证实。Objective To access the impact of hypertension on the electroanatomical characteristics of patients with atrial fibrillation（AF）.Methods This study included 213 patients who underwent circumferential pulmonary vein isolation（CPVI）of AF,guided by a CARTO mapping system.The subjects were divided into three groups according to their AF subtype：Group 1：paroxysmal AF mapped in sinus rhythm（n=88）,Group 2：paroxysmal AF mapped in AF rhythm（n=48）and Group 3：persistent AF（n=77）,each group was divided into two subgroup according to with or without hypertension.The mean voltage,scar area,and low voltage zone were obtained by using a CARTO mapping system before ablation.Several parameters,including the gender,AF duration,left atrial（LA）diameter were analyzed.Results In Group 1,the non-hypertension group had a significantly higher LA bipolar voltage compared with the hypertension AF patients（1.90 vs 1.29 mV,P0.05）.The LA bipolar voltage exhibited a significant reduction and less low voltage zone（0.064 vs 0.136,P0.05）than the hypertension group.In group 2 and 3,the LA bipolar voltage exhibited a significant reduction（1.27 vs 1.03 mV,0.72 vs 0.47 mV;both P0.05）,and more low voltage zone（0.101 vs 0.129,0.545 vs 0.687;both P0.05）could be observed in patients with hypertension.Interestingly,in spite of the AF substrates difference,the AF recurrence rate was similar in the patients with or without hypertension in the Group 1,2,and 3（all P0.05）.Conclusion Hypertension has a significant impact on the LA substrate of AF.However,these substrates haven＇t exhibited impact on the outcome of AF ablation.Further studies are needed to evaluate the relationship between these substrate changes and AF genesis in hypertension patients.

关 键 词：高血压 心房颤动 射频电流 导管消融 电解剖特征 

分 类 号：R541.7[医药卫生—心血管疾病] R544.1[医药卫生—内科学]