Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins - Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation
Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins - Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation
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DOI：
10.1161/01.cir.100.18.1879
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发表时间：
1999-11-02
期刊：
影响因子：
37.8
通讯作者：
Chang, MS
中科院分区：
文献类型：
--
作者：
Chen, SA;Hsieh, MH;Chang, MS
背景-心房颤动（AF）可由异位心搏引发。本研究调查了肺静脉（PV）的解剖特征和电生理特性，以及异位病灶的可能机制和对药物的反应。并评估射频（RF）消融对源自 PV 的异位搏动引发的 AF 的影响。方法和结果 - 纳入 79 例频繁发作的阵发性 AF 患者和 10 名对照患者，远端 PV 表现出最短的有效不应期（ERP），右上 PV 表现出比左上 PV 更高的 PV 内传导阻滞发生率。上侧 PV 和左侧 PV 的心肌袖分别比下侧 PV 和右侧 PV 更长。 AF 患者和对照患者的这些电生理学特征相似。普萘洛尔、维拉帕米和普鲁卡因酰胺抑制源自 PV 的异位搏动。在引发 AF 的 116 个异位病灶中，103 个 (88.8%) 源自 PV，平均 7 +/- 3 次 RF 应用完全消除了 110 个异位病灶 (94.8%)。在6+/-2个月的随访期间，68名患者（86.1%）在未服用任何抗心律失常药物的情况下没有出现房颤。后续经食管超声心动图显示 42.4% 的消融 PV 出现局灶性狭窄。 1例患者消融后出现轻度劳力性呼吸困难，3个月后缓解；我的患者在消融后5个月出现轻度劳力性呼吸困难。结论-PV的电生理特征与心房的电生理特征不同。 PV 的异位搏动可引发 AF，而 β-肾上腺素能受体阻滞剂、钙通道阻滞剂和钠通道阻滞剂可抑制这些异位搏动。仔细标测并消除这些异位病灶可以治愈阵发性房颤。
Background-Atrial fibrillation (AF) can be initiated by ectopic beats originating This study investigated the anatomic characteristics and electrophysiological properties of pulmonary veins (PVs), as well as the Possible mechanisms and response to drugs of ectopic foci. and assessed the effects of radiofrequency (RF) ablation on AF initiated by ectopic beats originating from PVs.Methods ann Results-Seventy-nine patients with frequent episodes of paroxysmal AF and 10 control patients were included, Distal PVs showed the shortest effective refractory periods (ERPs), and right superior PVs showed a higher incidence of intra-PV conduction block than left superior PVs. Superior and left PVs had longer myocardial sleeves than inferior and right PVs, respectively. These electrophysiological characteristics were similar between AF and control patients. Propranolol, verapamil, and procainamide suppressed ectopic beats that originated from the PVs. Of 116 ectopic foci that initiated AF, 103 (88.8%) originated from PVs, A mean of 7 +/- 3 RF applications completely eliminated 110 ectopic foci (94.8%). During the 6 +/- 2-month follow-up period, 68 patients (86.1%) were free of AF without any antiarrhythmic drugs. Follow-up transesophageal echocardiogram showed 42.4% of ablated PVs had focal stenosis. One patient had mild exertional dyspnea after ablation, but it resolved 3 months later; I patient had onset of mild exertional dyspnea 5 months after ablation.Conclusions-Electrophysiological characteristics of PVs are different from those in the atria. Ectopic beats from PVs can initiate AF, and beta-adrenergic receptor blocker, calcium channel blockers, and sodium channel blockers can suppress these ectopic beats. Careful mapping and elimination of these ectopic, foci can cure paroxysmal AF.