Atrial cellular electrophysiological changes in patients with ventricular dysfunction may predispose to AF.
Atrial cellular electrophysiological changes in patients with ventricular dysfunction may predispose to AF.
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DOI：
10.1016/j.hrthm.2008.12.028
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发表时间：
2009-04
期刊：
影响因子：
5.5
通讯作者：
Rankin, Andrew C.
中科院分区：
文献类型：
--
作者：
Workman, Antony J.;Pau, Davide;Redpath, Calum J.;Marshall, Gilhan E.;Russell, Julie A.;Norrie, John;Kane, Kathleen A.;Rankin, Andrew C.
关键词：
左心室收缩功能障碍（LVSD）是心房颤动（AF）的危险因素，但心房细胞电生理机制尚不清楚。研究窦性心律（SR）患者的LVSD是否与心房细胞电生理变化相关，这些变化可能易患AF。从214例接受心脏手术的SR患者中获得右心房肌细胞。采用全细胞膜片钳技术测量动作电位或离子电流。中度或重度LVSD的存在与缩短的心房细胞有效不应期（ERP）相关（209±8 ms; 52个细胞，18例vs 233±7 ms; 134个细胞，49例; P<0.05）;经多元线性回归分析证实。中、重度LVSD组LVEF（36± 4%，n=15）显著低于无LVSD组（62± 2%，n=31）（P<0.05）。在LVEF≤ 45%患者的细胞中，90%复极时的ERP和动作电位时程分别比LVEF> 45%患者的短24%和18%。LVEF与ERP呈正相关（r=0.65，P<0.05）。L型钙离子电流、内向整流钾离子电流和持续外向离子电流不受LVSD的影响。瞬时外向钾离子电流降低了34%，其激活电压正移，其衰减动力学没有变化。SR患者的LVSD与心房细胞ERP的缩短独立相关，这可能有助于AF的易感性。
Left ventricular systolic dysfunction (LVSD) is a risk factor for atrial fibrillation (AF), but the atrial cellular electrophysiological mechanisms in humans are unclear. To investigate whether LVSD in patients who are in sinus rhythm (SR) is associated with atrial cellular electrophysiological changes which could predispose to AF. Right atrial myocytes were obtained from 214 consenting patients in SR who were undergoing cardiac surgery. Action potentials or ion currents were measured using the whole-cell-patch clamp technique. The presence of moderate or severe LVSD was associated with a shortened atrial cellular effective refractory period, ERP (209±8 ms; 52 cells, 18 patients vs 233±7 ms; 134 cells, 49 patients; P<0.05); confirmed by multiple linear regression analysis. The LV ejection fraction (LVEF) was markedly lower in patients with moderate or severe LVSD (36±4%, n=15) than in those without LVSD (62±2%, n=31; P<0.05). In cells from patients with LVEF≤45%, the ERP and action potential duration at 90% repolarisation were shorter than in those from patients with LVEF>45%, by 24 and 18%, respectively. The LVEF and ERP were positively correlated (r=0.65, P<0.05). The L-type calcium ion current, inward rectifier potassium ion current, and sustained outward ion current was unaffected by LVSD. The transient outward potassium ion current was decreased by 34%, with a positive shift in its activation voltage, and no change in its decay kinetics. LVSD in patients in SR is independently associated with a shortening of the atrial cellular ERP, which may be expected to contribute to a predisposition to AF.
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