Increased dispersion of refractoriness in patients with atrial fibrillation in the early postoperative period after coronary artery bypass grafting
Increased dispersion of refractoriness in patients with atrial fibrillation in the early postoperative period after coronary artery bypass grafting
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DOI：
10.1046/j.1540-8167.2003.02218.x
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发表时间：
2003-01-01
影响因子：
2.7
通讯作者：
Tasdemir, O
中科院分区：
文献类型：
--
作者：
Soylu, M;Demir, AD;Tasdemir, O
心房有效不应期（AERP）弥散度增加与心房颤动（AF）易感性密切相关。然而，对于冠状动脉旁路移植术（CABG）患者术后房颤的发展可能起重要作用的心房异常的术前电生理特征，尚未有详细的研究。方法和结果：56例连续行CABG的患者被纳入本研究。对术后早期发生房颤的18例患者（男性14例，女性4例，平均年龄57.7 +/- 5.2岁）和未发生房颤的38例患者（男性28例，女性10例，平均年龄56.3 +/- 6.4岁）进行术前临床、超声心动图、血管造影和电生理参数的比较。术后早期发生AF的患者术前PA间期和AERP弥散值较高（P < 0.05）。PA间期（P < 0.05，优势比= 1.64,95%可信区间1.17-2.30），右高心房AERP(AERP(HRA)；P < 0.05，优势比= 0.94,95%可信区间0.91-0.97)，右后外侧心房AERP(AERP(RPL)；P < 0.05，优势比= 0.79,95%可信区间0.63-0.98)，冠状窦远端AERP(AERP(DCS)；单因素分析中，P < 0.05，优势比= 0.84,95%可信区间0.74-1.02)和AERP离散度（P < 0.001，优势比= 1.29,95%可信区间1.12-1.47）与cabg后房颤独立相关。结论：AERP弥散度是心房易感性的一种合适的电生理指标。术前AERP弥散度和PA间期增高可能提示患者在冠状动脉搭桥术术后早期有发生房颤的高风险。
Introduction: Increased atrial effective refractory period (AERP) dispersion is well correlated with vulnerability to atrial fibrillation (AF). However, the preoperative electrophysiologic characteristics of atrial abnormalities that may play an important role in the development of AF postoperatively in patients with coronary artery bypass grafting (CABG) have not been investigated in detail.Methods and Results: Fifty-six consecutive patients who underwent CABG were enrolled in this study. Eighteen patients (14 men and 4 women; mean age 57.7 +/- 5.2 years) with AF in the early postoperative period and 38 patients (28 men and 10 women; mean age 56.3 +/- 6.4 years) without AF were compared with regard to preoperative clinical, echocardiographic, angiographic, and electrophysiologic parameters. Preoperative PA interval and AERP dispersion values were higher (P < 0.05) in patients who developed AF in the early postoperative period. PA interval (P < 0.05, odds ratio = 1.64, 95% confidence interval 1.17-2.30), AERP in the high right atrium (AERP(HRA); P < 0.05, odds ratio = 0.94, 95% confidence interval 0.91-0.97), AERP in the right posterolateral atrium (AERP(RPL); P < 0.05, odds ratio = 0.79, 95% confidence interval 0.63-0.98), AERP in the distal coronary sinus (AERP(DCS); P < 0.05, odds ratio = 0.84, 95% confidence interval 0.74-1.02), and AERP dispersion (P < 0.001, odds ratio = 1.29, 95% confidence interval 1.12-1.47) were independently related to post-CABG AF in univariate analysis. Increases in preoperative PA interval and AERP dispersion were found to be associated with a high risk for development of post-CABG AF.Conclusion: AERP dispersion is a suitable electrophysiologic indicator for atrial vulnerability. The presence of increased preoperative AERP dispersion and PA interval may indicate patients at high risk for development of AF in the early postoperative period after coronary artery bypass grafting.