Impact of premature atrial contractions in atrial fibrillation
Impact of premature atrial contractions in atrial fibrillation
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DOI：
10.1111/j.1540-8159.2004.00462.x
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发表时间：
2004-04-01
影响因子：
1.8
通讯作者：
Thomsen, B
中科院分区：
文献类型：
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作者：
Jensen, TJ;Haarbo, J;Thomsen, B
Jensen，T.J.，等人：房性早搏对房颤的影响。尽管人们对阵发性房颤(PAF)的认识越来越多，但在未选择的患者中诱发模式的细节还很少，本文重点研究了连续发生房颤的108例患者中自发发作的触发机制。连续108例患者在过去一年内有两次或两次以上的心电图记录的房颤发作，进行了24小时Holter记录，回顾了所有的房颤发作(n=157)，并在失去的10次房颤发作前对其进行了回顾。在25 mm/S纸上测量PP间期，计数房性早搏(PAC)。此外，还测量了未触发房颤的PAC的随机选择的偶联间期(PP‘)，并将其与房颤触发间期和健康对照组的PP’间期进行了比较。PAC先于所有的房颤发作。房颤启动前的PP偶联间期和PAC数目在受试者内和受试者之间表现出广泛的差异。在启动前最后10个节拍内的PAC发作中，我们在启动时观察到一个长-短的PP序列。房颤触发PAC的PP‘间期(+/-SE)为403+/-9ms，显著短于非触发PAC的PP’间期(584+/-8ms)和PAC的PP‘间期(589.6ms)，P<0.0001。然而，很大比例的非触发PAC具有较短的PP‘偶联间期而不会触发AE。这些观察强调了除触发本身之外的其他因素的重要性，如致心律失常的底物，并建议旨在治疗PAF的治疗操作应针对这些因素以及触发机制。
JENSEN, T.J., ET AL.: Impact of Premature Atrial Contractions in Atrial Fibrillation. In spite of the increasing knowledge about paroxysmal atrial fibrillation (PAF), details on mode of initiation in unselected patients are scarce, This paper focuses on trigger mechanisms of spontaneous onset of AF in consecutive patients with PAF One hundred eight consecutive patients with two or more ECG documented AF episodes within the previous year had a 24-hours Holter recording performed, All AF episodes (n = 157) were reviewed and, within the lost 10 beats prior to AF initiation. PP intervals were measured on 25 mm/s paper printouts and premature atrial contractions (PACs) were counted. Additionally, randomly selected coupling intervals (PP') for PACs not triggering AF were measured and compared to AF triggering intervals and to PP' intervals from healthy controls. PACs preceded all AF episodes. AF initiation displayed a wide variety in terms of PP coupling intervals and number of PACs prior to initiation within and between subjects. In episodes with PACs within the last 10 beats prior to initiation, we observed a long-short PP sequence at the time of initiation. Mean PP' interval (+/- SE)for AF triggering PACs was 403 +/- 9 ms, significantly shorter, P < 0.0001, than PP' for nontriggering PACs (584 +/- 8 ms) and PACs in healthy controls (589 6 ms). However, a large proportion of nontriggering PACs hod short PP' coupling intervals without triggering AE These observations highlight the importance of other factors than the trigger per se, such as the arrhythmogenic substrate, and suggest that therapeutic maneuvers aimed at Curing PAF should target these as well as the trigger mechanisms.