Inducibility of paroxysmal atrial fibrillation by isoproterenol and its relation to the mode of onset of atrial fibrillation
Inducibility of paroxysmal atrial fibrillation by isoproterenol and its relation to the mode of onset of atrial fibrillation
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DOI：
10.1111/j.1540-8167.2007.01089.x
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发表时间：
2008-05-01
影响因子：
2.7
通讯作者：
Morady, Fred
中科院分区：
文献类型：
--
作者：
Oral, Hakan;Crawford, Thomas;Morady, Fred
阵发性心房颤动的诱导：背景：异丙肾上腺素已被用于评估阵发性房颤导管消融术的诱导。然而，目前还没有研究确定异丙肾上腺素诱导房颤的敏感性和特异性，也不清楚异丙肾上腺素在诱导迷走神经紧张型、肾上腺素能型和随机型房颤的临床亚型中是否同样有效。目的：确定异丙肾上腺素诱导房颤（AF）的敏感性和特异性。在20例无房颤史的对照组和80例阵发性房颤患者中，以5，10，15和20 μ g/min的速度每隔2分钟输注异丙肾上腺素，或直至诱发房颤。80例阵发性房颤患者中，67例（84%）诱发持续性房颤（P < 0.001）。迷走神经紧张性AF患者中15/17例（88%）、肾上腺素能性AF患者中11/11例（100%）和AF随机发作患者中41/52例（79%）发生异丙肾上腺素诱导的AF（P = 0.2）。异丙肾上腺素5 μ g/min、10 μ g/min、15 μ g/min、20 μ g/min时，AF产率分别为11%（9/80）、28%（22/80）、51%（40/78）、88%（67/76），差异有显著性（P < 0.01）。在达到最大剂量之前，由于可逆性胸痛或收缩压< 85 mmHg.Conclusions：异丙肾上腺素在输注速率高达20 μ g/min时对PAF患者诱导AF具有高敏感性（88%）和特异性（95%），无论临床亚型是否为迷走神经紧张性、肾上腺素能或随机。
Inducibility of Paroxysmal Atrial Fibrillation.Background: Isoproterenol has been used to assess inducibility during catheter ablation for paroxysmal PAF. However, no studies have determined the sensitivity and specificity of isoproterenol for the induction of AF. It also is not clear whether isoproterenol is equally effective in inducing AF in the clinical subtypes of vagotonic, adrenergic, and random AF.Objective: To determine the sensitivity and specificity of isoproterenol for the induction of atrial fibrillation (AF).Methods: Isoproterenol was infused at 5, 10, 15, and 20 mu g/min at 2-minute intervals or until AF was induced in 20 control subjects with no history of AF and in 80 patients with PAF.Results: Among the 20 control subjects, AF was induced by isoproterenol in one patient (5%). Among the 80 patients with PAF, persistent AF was induced in 67 patients (84%, P < 0.001). Isoproterenol induced AF in 15 of 17 patients (88%) with vagotonic AF, 11 of 11 patients (100%) with adrenergic AF, and 41 of 52 patients (79%) with random episodes of AF (P = 0.2). The yield of AF was 11% (9/80) after 5 mu g/min, 28% (22/80) after 10 mu g/min, 51% (40/78) after 15 mu g/min, and 88% (67/76) after 20 mu g/min of isoproterenol (P < 0.01). Isoproterenol had to be discontinued in four patients (5%) before reaching the maximum dose due to reversible chest pain or systolic blood pressure < 85 mmHg.Conclusions: Isoproterenol at infusion rates up to 20 mu g/min has a high sensitivity (88%) and specificity (95%) for induction of AF in patients with PAF, regardless of whether the clinical subtype is vagotonic, adrenergic, or random.