心房颤动患者心房肌动作电位时程频率适应性研究  

Rate adaption of action potential duration in the human right atrium with paroxysmal lone atrial fibrillation

作　　者：徐云[1] 单其俊[1] 陈明龙[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心内科

出　　处：《中华心血管病杂志》2003年第7期491-493,共3页Chinese Journal of Cardiology

摘　　要：目的　研究阵发性孤立性心房颤动 (房颤 )患者及对照组心房肌动作电位时程 (APD)频率适应性的差异 ,阐明其与房颤发生有关的可能机制。方法　应用同时具有起搏功能的Ag AgCl电极记录单向动作电位 (MAP) ,房颤组和对照组各入选 11例患者 ,在逐渐递减的 9个起搏周长分别记录MAP并测量APD90 、APD90 50 。所有房颤患者MAP记录前 1个月无房颤发作史 ,以排除电重塑影响。结果　在较长起搏周长 (6 0 0、5 5 0、5 0 0ms) ,房颤组APD90 显著短于对照组 (P <0 0 5 ) ;在较短起搏周长(340、30 0、2 80ms) ,房颤组APD90 又显著长于对照组 (P <0 0 5 )。同样APD90 50 在较长起搏周长 (6 0 0、5 5 0、5 0 0、4 6 0ms) ,房颤组显著短于对照组 (P <0 0 5 ) ;而较短起搏周长 (340、30 0、2 80ms)两组无差别。结论　心房肌APD频率适应性曲线在阵发性孤立性房颤组与对照组有所不同 ,其可能与房颤的最初发生和维持有关 ,机制存在于离子通道水平。Objective To investigate the difference in rate adaption of action potential duration(APD) in right atrium between patients with paroxysmal isolated atrial fibrillation(AF) and controls. Methods Eleven patients [mean AF history (46±31) months] were studied as AF group.Monophasic action potentials at 90% and 50% of repolarization(APD 90,APD 50) were measured during 9 cycle lengths(CLs) including 600,550,500,460,420,380,340,300 and 280 ms.Also APD 90-50 was calculated in each patient.Eleven atrioventricular nodal reentrant tachycardia with no history of AF and normal heart structure served as a control group. Results APD 90 at longer CLs (600,550,500 ms )in the AF group was significantly shorter than that in the controls [(219.27±9.68,219.64±9.63,219.55±5.92) ms vs (245.09±10.48,236.18±8.92,231.91±10.80) ms,P<0.05, respectively], but at shorter CLs (340,300,280 ms) APD 90 was longer than that in control group [(195.36±14.51,193.91±13.00,189.64±15.66)ms vs (179.18±10.52,173.45±9.21,165.73±10.56)ms,P<0.05, respectively].APD 90-50 at longer CLs (600, 550, 500,460 ms) in the AF patients was also significantly shorter than that in the controls [(72.09±12.55,72.55±11.84,69.36±13.02, 60.36±10.73)ms vs (89.45±15.28,88.36±12.71,86.18±7.47,79.00±8.26)ms,P<0.05, respectively].However, there was no significant difference at rapid pacing between two groups. Conclusion The changes of rate adaption of APD in right atrium of patients with paroxysmal isolated AF have been present before “electrical remodeling”, and these alterations of the electrical property are partly associated with the occurrence and maintenance of AF initially.

关 键 词：心房颤动 心房肌 动作电位 时程 频率 适应性 电生理学 

分 类 号：R541.7[医药卫生—心血管疾病]