Premature Atrial Contraction Location and Atrial Fibrillation Inducibility.
Premature Atrial Contraction Location and Atrial Fibrillation Inducibility.
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心房过早收缩位置和心房颤动诱发性。
DOI：
10.1161/circep.122.011623
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Marcus,GregoryM
中科院分区：
文献类型：
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作者：
Howell,StaceyJ;Dukes,JonathanW;Vittinghoff,Eric;Tang,JanetJ;Moss,JoshuaD;Lee,RandallJ;Lee,ByronK;Tseng,ZianH;Vedantham,Vasanth;Olgin,JeffreyE;Scheinman,MelvinM;Hsia,Henry;Gerstenfeld,EdwardP;Marcus,GregoryM
房性早搏(PAC)常诱发房颤(AF)。1肺静脉(PV)是PAC触发的房颤最常见的起源，有两种可能的解释1：PAC一般导致房颤，且PV是最常见的起源，或者PV PAC特别导致心律失常。PAC频率预测房颤的风险，2提示根除PAC可能有效地预防房颤，并迫切需要确定最有责任的PAC类型。利用假日试验的数据(酒精如何诱发房性心律失常)，我们测试了静脉曲张引起的PAC更有可能诱发房颤的假设。PAC在窦性心律期间应用于接受PVI消融的患者，这是一项随机双盲试验，有100名患者参加，评估了注射酒精和安慰剂期间的心房电生理学。3按冠状静脉窦近端、冠状静脉窦远端、终缘高位、左上肺静脉、右上肺静脉顺序行PAC起搏。如果预期的上PV是电气隔离的，则使用同侧的下PV；如果两者都隔离，则使用距离预期PV最近的捕获位置。给予600ms 8拍驱动序列(S1)，并采用递增方法，在140ms给S2，并增加10ms，直到发生心房俘获。第一次捕捉到的起搏的S2偶联间期构成了从该部位发出的PAC，也定义了该部位的心房有效不应期(AERP)。每次PAC后记录非持续性(<；30秒)和持续性(>；30秒)房颤。然后开始研究输注，并重复相同的方案。这项研究由加州大学旧金山分校批准
Premature atrial contractions (PACs) frequently initi-ate atrial fibrillation (AF). 1 The pulmonary veins (PVs) are the most common origin of PAC-triggered AF, with 2 possible explanations1: either PACs generally lead to AF, and the PVs are the most common origin, or PV PACs are particularly arrhythmogenic. PAC frequency predicts AF risk, 2 suggesting that PAC eradication might effectively prevent AF and compelling the identification of the most culpable PAC type. Leveraging data from the HOLIDAY trial (How Alcohol Induces Atrial Arrhythmias), we tested the hypothesis that PACs arising from the PVs are more likely to induce AF. PACs were administered during sinus rhythm to patients undergoing PVI ablation in a prospective protocol as part of HOLIDAY, a randomized, double-blind trial of 100 patients that evaluated atrial electrophysiology during infusion of alcohol versus placebo. 3 PACs were administered using paced extrastimuli in order from the proximal coronary sinus, distal coronary sinus, high crista terminalis, left upper PV, and right upper PVs. If the intended upper PV was electrically isolated, the ipsilateral lower PV was used; if both were isolated, the captured site closest to the intended PV was utilized. A 600 ms 8-beat drive train (S1) was administered, and, using a step-up approach, S2 was administered at 140 ms and increased by 10 ms until atrial capture occurred. The S2 coupling interval of the first captured beat constituted the PAC delivered from that site, also defining that site’s atrial effective refractory period (AERP). Nonsustained (< 30 seconds) and sustained (> 30 seconds) AF was documented after each PAC. The study infusion was then initiated, and the same protocol was repeated. The study was approved by the University of California-San