Time-Dependent Changes in QT Dynamics after Initiation and Termination of Paroxysmal Atrial Fibrillation
Time-Dependent Changes in QT Dynamics after Initiation and Termination of Paroxysmal Atrial Fibrillation
复制标题
DOI：
10.1111/pace.12746
复制
发表时间：
2015-12-01
影响因子：
1.8
通讯作者：
Inoue, Hiroshi
中科院分区：
文献类型：
--
作者：
Yamaguchi, Yoshiaki;Mizumaki, Koichi;Inoue, Hiroshi
背景：阵发性房颤(房颤)患者房颤发作后及恢复窦性心律(SR)后QT动力学随时间变化的情况鲜为人知。方法：在24小时动态心电图上自动测量13例房颤和窦性心律患者CM5导联QT间期和RR间期。分别在房颤发作前1h(Pre(0~1h))、房颤发作后0~1h和4~5h(房颤(0~1h)和房颤(4~5h))、房颤恢复后0~1h、2~3h和4~5h(SR0~1h、SR2~3h和SR4~5h)6个时间段分析QT-RR关系。SR4-5h的斜率大于AF(4-5h)和AF(0-1h)。在接受抗心律失常药物治疗的患者(n=5)中，在SR4-5h时QT-RR斜率大于未接受抗心律失常药物治疗的患者(n=8)。结论：阵发性房颤患者房颤期间心动过缓依赖性QT延长减弱，随着心律失常持续时间的延长，QT-RR斜率逐渐增加，尤其是房颤患者。这可能会增加患尖端扭曲症的风险。
Background: Little is known about time-dependent changes in QT dynamics after initiation of atrial fibrillation (AF) and after restoration of sinus rhythm (SR) in patients with paroxysmal AF.Methods: Beat-to-beat QT and RR intervals in CM5 lead were measured automatically in 13 patients with both AF and SR on the single 24-hour Holter electrocardiology recording. QT-RR relation was analyzed at six periods of time: 1 hour before AF onset (Pre(0-1h)), 0-1 hour and 4-5 hours after AF onset (AF(0-1h) and AF(4-5h)), and 0-1 hour, 2-3 hours, and 4-5 hours after the restoration of SR (SR0-1h, SR2-3h, and SR4-5h).Results: QT-RR slope was gradually decreased after AF onset and gradually returned to the baseline level after restoration of SR. The slope became greater at SR4-5h than at AF(4-5h) and AF(0-1h). In patients receiving antiarrhythmic drugs (AADs; n= 5), QT-RR slope was greater at SR4-5h than in those not receiving AADs (n = 8).Conclusion: In patients with paroxysmal AF, bradycardia-dependent QT prolongation was attenuated during AF, and was corrected and gradually augmented along with continuation of SR, especially in patients receiving AADs. This could increase the risk of developing torsade de pointes.