Insights into new-onset atrial fibrillation following open heart surgery and implications for type II atrial flutter
Insights into new-onset atrial fibrillation following open heart surgery and implications for type II atrial flutter
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DOI：
10.1093/europace/euv019
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发表时间：
2015-12-01
期刊：
影响因子：
6.1
通讯作者：
Sahadevan, Jayakumar
中科院分区：
文献类型：
--
作者：
Sadrpour, Shervin A.;Srinivasan, Deepa;Sahadevan, Jayakumar
目的心脏直视手术(OHS)后新发房颤--术后房颤(POAF)被认为与心包炎有关。基于对犬无菌心包炎模型的房颤研究，我们假设OHS后患者的POAF可能与左心房(LA)快速、规则的节律有关，这提示LA司机维持房颤。本研究的目的是验证这样一种假设：在POAF患者中，仔细选择的两个左房部位中的至少一个部位记录的房电(AEGs)将呈现快速、规则的节律，其周期长度(CL)短且形态恒定，而选定的右房(RA)部位的AEGs将表现为不规则的CLS和不同的形态。方法与结果对44例OHS患者在持续房颤期间从RA心外膜表面、Bachmann束的LA部分和LA后部记录的AEGs进行分析，以了解其CL和形态的规律性。44例患者中有15例发生持续性房颤。15例患者中有11例记录到心房电活动；11例患者中有8例在至少一个左房部位记录到形态恒定的快速、有规律的激动；在11例患者中有3例患者不存在有规律的AEG部位。结论持续性POAF期间记录的心房电信号经常显示至少一个左房部位有快速、有规律的激动，与司机维持房颤的情况一致。
Aims Postoperative atrial fibrillation (POAF), new-onset AF after open heart surgery (OHS), is thought to be related to pericarditis. Based on AF studies in the canine sterile pericarditis model, we hypothesized that POAF in patients after OHS may be associated with a rapid, regular rhythm in the left atrium (LA), suggestive of an LA driver maintaining AF. The aim of this study was to test the hypothesis that in patients with POAF, atrial electrograms (AEGs) recorded from at least one of the two carefully selected LA sites would manifest a rapid, regular rhythm with AEGs of short cycle length (CL) and constant morphology, but a selected right atrial (RA) site would manifest AEGs with irregular CLs and variable morphology.Methods and results In 44 patients undergoing OHS, AEGs recorded from the epicardial surface of the RA, the LA portion of Bachmann's bundle, and the posterior LA during sustained AF were analysed for regularity of CL and morphology. Sustained AF occurred in 15 of 44 patients. Atrial electrogramswere recorded in 11 of 15 patients; 8 of 11 had rapid, regular activation with constant morphology recorded from at least one LA site; no regular AEG sites were present in 3 of 11 patients.Conclusions Atrial electrograms recorded during sustained POAF frequently demonstrated rapid, regular activation in at least one LA site, consistent with a driver maintaining AF.