Remodeling of sinus node function in patients with congestive heart failure - Reduction in sinus node reserve
Remodeling of sinus node function in patients with congestive heart failure - Reduction in sinus node reserve
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DOI：
10.1161/01.cir.0000139336.69955.ab
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发表时间：
2004-08-24
期刊：
影响因子：
37.8
通讯作者：
Kalman, JM
中科院分区：
文献类型：
--
作者：
Sanders, P;Kistler, PM;Kalman, JM
背景-实验和临床研究已证明充血性心力衰竭（CHF）中存在弥漫性心房重构。我们假设 CHF 患者会表现出窦房结功能紊乱。方法和结果 - 对 18 名有症状的 CHF 患者（左心室射血分数，26 +/- 5%）和 18 名年龄匹配的对照受试者进行了研究。在自主神经阻滞下，评估以下内容：固有窦周期长度、校正窦房结恢复时间（CSNRT）、窦房传导时间、沿终嵴的分段电图或双电位的数量和持续时间，以及最早窦房结活动的位置。进行电解剖测绘以评估窦房结复合体的位置和性质，表征窦房传播，并评估沿终嵴的传导异常和电压幅度。与年龄匹配的对照受试者相比，CHF 患者表现出以下发现：固有窦性周期长度延长 ( P = 0.005)、CSNRT 延长 ( P < 0.0001)、窦性心律期间 ( P = 0.03) 和起搏后 ( P = 0.002) 窦性活动尾部定位、窦房传导时间延长 ( P = 0.02)、更多 ( P < 0.0001)沿终嵴的分段电图或双电位的持续时间（P < 0.0001）和持续时间（P < 0.0001），沿终嵴的电压幅度损失（P = 0.02），以及窦脉冲的异常和迂回传播。 结论 - 这项研究表明，CHF 患者具有显着的窦房结重塑，其特征是沿终嵴的解剖和结构变化，以及功能性窦房结储备减少。这一发现可能对 CHF 临床心动过缓的发展以及在这种情况下使用负变时剂和起搏具有影响。
Background - Experimental and clinical studies have demonstrated diffuse atrial remodeling in congestive heart failure (CHF). We hypothesized that patients with CHF would demonstrate derangement of sinus node function.Methods and Results - Eighteen patients with symptomatic CHF ( left ventricular ejection fraction, 26 +/- 5%) and 18 age-matched control subjects were studied. Under autonomic blockade, the following were evaluated: intrinsic sinus cycle length, corrected sinus node recovery time (CSNRT), sinoatrial conduction time, number and duration of fractionated electograms or double potentials along the crista terminalis, and location of the earliest sinus activity. Electroanatomic mapping was performed to evaluate the location and nature of the sinus node complex, to characterize sinoatrial propagation, and to evaluate conduction abnormalities and voltage amplitude along the crista terminalis. Patients with CHF demonstrated the following findings compared with age-matched control subjects: prolongation of the intrinsic sinus cycle length ( P = 0.005), prolongation of CSNRT ( P < 0.0001), caudal localization of sinus activity both during sinus rhythm ( P = 0.03) and after pacing ( P = 0.002), prolongation of sinoatrial conduction time ( P = 0.02), greater number ( P < 0.0001) and duration ( P < 0.0001) of fractionated electrograms or double potentials along the crista terminalis, loss of voltage amplitude along the crista terminalis ( P = 0.02), and abnormal and circuitous propagation of the sinus impulse.Conclusions - This study demonstrates that patients with CHF have significant sinus node remodeling characterized by anatomic and structural changes along the crista terminalis with a reduction in functional sinus node reserve. This finding may have implications for the development of clinical bradycardia in CHF and for the use of negatively chronotropic agents and pacing in this condition.