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|本期目录/Table of Contents|

不同方式起搏后人心房压力和心房有效不应期的变化

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第6期
页码:
881-883
栏目:
临床研究
出版日期:
2010-08-23

文章信息/Info

Title:
Changes of atrial pressure and atrial effective refractory period using different pacing modes in humans
作者:
杜荣增1; 邱建平1; 廖德宁2; 任雨笙2; 张家友2; 朱华1; 汤永庆1
1.上海市公利医院心血管内科,上海 200135；2.上海市长征医院心血管内科，上海 200001
Author(s):
DU Rong-zeng1;  QIU Jian-ping1;  LIAO De-ning2;  REN Yu-sheng2;  ZHANG Jia-you2;  ZHU Hua1;  TANG Yong-qing1
1.Department of Cardiovasology, Gongli Hospital, Pudong New Area, Shanghai 200135, China; 2.Department of Cardiovasology, Affiliated Changzhen Hospital, Second Military Medical University, Shanghai 200001, China
关键词:
心房颤动; 起搏方式; 机械电反馈; 心房压力; 心房有效不应期
Keywords:
atrial fibrillation;  pacing modes;  mechanoelectrical feedback;  atrial pressure;  atrial effective refractory period
分类号:
R541.71
DOI:
-
文献标识码:
A
摘要:
目的: 32例接受导管射频消融治疗后的阵发性室上性心动过速患者，均无器质性心脏病。分别进行高位右心房（HRA）部位快速右心房起搏（AP）、右心室心尖部（RVA）快速心室起搏（RVP）、HRA+RVA部位房室同步起搏（SAVPHRA+RVA）以及冠状窦远端（CSd）+RVA部位房室同步起搏（SAVPCSd+RVA），起搏周长均为400 ms，持续时间各5 min。分别测量不同起搏方式起搏前后心房压力和HRA与CSd部位的心房有效不应期（ERPA）（ERPHRA、ERPCSd）。结果： 与窦性节律（SR）时比较，AP对心房压力无明显影响［(9±4)cmH2O vs. (7±3)cmH2O，1 cmH2O=0.098 kPa］；与SR及AP比较，RVP、SAVPHRA+RVA、SAVPCSd+RVA使心房压力升高［（14±4）、(13±4)、(15±4)cmH2O，均P<0.01］；RVP和SAVPHRA+RVA、SAVPCSd+RVA等不同起搏方式升高心房压力作用基本相当。AP、RVP及SAVPHRA+RVA、SAVPCSd+ RVA等不同起搏方式均使ERPA（ERPHRA、ERPCSd）较起搏前缩短（均P<0.05）。SAVPHRA+RVA使ERPHRA较单纯AP/单纯RVP均有进一步缩短［（24±14）ms vs.(15±11)/(13±9)ms，均P<0.05］。SAVPCSd+RVA使ERPCSd较单纯AP/单纯RVP均有进一步缩短［（23±15）ms vs.(15±12)/(14±11)ms，均P<0.05］。结论： 单纯RVP及SAVP均升高心房压力，且作用相当；而单纯RVP是替代SAVP研究心房机械电反馈（MEF）的理想方法。不同方式起搏可导致HRA与CSd部位的ERPA缩短。
Abstract:
AIM: To evaluate the effects of an acute atrial stretch on atrial pressure and the effective refractory period of atrium (ERPA) in humans. METHODS: Thirty-two patients without structural heart diseases who were treated with catheter radiofrequency ablation due to paroxysmal supraventricular tachycardia were enrolled for this study. Atrial pressure and ERPA at high right atrium (HRA) and distal coronary sinus (CSd) were evaluated during sinus rhythm, rapid atrial pacing (AP) at high right atrium (HRA), rapid ventricular pacing (RVP) at right ventricular apex (RVA), simultaneous AV, pacing at HRA+RVA (SAVPHRA+RVA) and simultaneous AV pacing at CSd+RVA (SAVPCSd+RVA) at a cycle length of 400 msec. RESULTS: Compared with those during sinus rhythm, no significant changes were observed in the mean right atrial pressure during AP ［(9±4) vs. (7±3) cmH2O, 1 cmH2O=0.098 kPa］ but the mean right atrial pressure increased significantly during RVP, SAVPHRA+RVA and SAVPCSd+RVA ［(14±4), (13±4), (15±4) cmH2O, P<0.01］ with no significant difference among the three. The ERPA shortened significantly using different pacing modes compared with that during sinus rhythm. ERPHRA further shortened during SAVPHRA+RVA ［(24±14) vs. (15±11)/(13±9) msec, P<0.05］ and ERPCSd further shortened during SAVPCSd+RVA ［(23±15) vs. (15±12)/(14±11) msec, P<0.05］ compared with those during AP and RVP. CONCLUSION: Both VP and SAVP increase atrial pressure. Simple RVP is a good alternative to SAVP in the study of atrial mechanoelectrical feedback (MEF). Different pacing modes all lead to the shortening of ERPA at HRA and CSd.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2009-11-18.作者简介：杜荣增，副主任医师，博士Email:adu306@sohu.com
更新日期/Last Update: 2010-08-22