A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology.
A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology.
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DOI：
10.1016/j.jacep.2020.11.026
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发表时间：
2021-05
影响因子：
7
通讯作者：
Gerstenfeld, Edward P.
中科院分区：
文献类型：
--
作者：
Marcus, Gregory M.;Dukes, Jonathan W.;Vittinghoff, Eric;Nah, Gregory;Badhwar, Nitish;Moss, Joshua D.;Lee, Randall J.;Lee, Byron K.;Tseng, Zian H.;Walters, Tomos E.;Vedantham, Vasanth;Gladstone, Rachel;Fan, Shannon;Lee, Emily;Fang, Christina;Ogomori, Kelsey;Hue, Trisha;Olgin, Jeffrey E.;Scheinman, Melvin M.;Hsia, Henry;Ramchandani, Vijay A.;Gerstenfeld, Edward P.
心房颤动(房颤)离散发作的发生机制尚不清楚。酒精似乎增加了房颤的风险，为研究可能导致心脏心律失常的电生理效应提供了机会。目的：研究酒精暴露对人体心房电生理的影响。在接受房颤消融手术的患者中，我们进行了一项随机、双盲、安慰剂对照试验，将静脉酒精滴定至0.08%的血液酒精浓度，与体积和渗透压匹配的面罩安慰剂进行比较。分别于注药前、注药后测量右、左、肺静脉心房有效不应期(AERP)和传导时间。采用异丙肾上腺素输注和阵发性心房起搏的方法评价房颤的诱发性。在100名参与者(每组50人)中，接受安慰剂治疗的患者更有可能患有糖尿病(22%vs4%，p=0.007)，并接受过房颤消融术(36%vs22%，p=0.005)。酒精组肺静脉AERP平均减少12ms(95%可信区间1-22ms，p=0.026)，而安慰剂组无变化(p=0.98.)。虽然在持续评估的AERP中没有观察到统计上的显著差异，但被测试的AERP部位中酒精减少的比例(中位数0.5，IQR0.6-0.6)大于安慰剂(中位数0.4，IQR0.2-0.6，p=0.0043)。未观察到传导时间或诱发性房颤的比例有统计学意义的差异。急性酒精暴露会降低AERP，尤其是肺静脉。这些数据表明，酒精、常见的生活方式暴露和人体心房的即刻心律失常效应之间存在直接的机制联系。在这项随机、双盲、安慰剂对照的静脉注射酒精滴定为0.08%的研究中，酒精导致肺静脉心房有效不应期显著缩短，与安慰剂相比，酒精导致更大比例的部位显示出较低的心房有效不应期。未观察到传导时间的改变或诱发房颤的差异。这些发现表明，酒精可以显著减少心房有效不应期，这一现象已知会使心房更容易发生纤颤，这提供了第一个机械证据，表明常见的生活方式因素可以急剧改变心脏电生理，增加心律失常的机会。
The mechanism by which a discrete episode of atrial fibrillation (AF) occurs remains unknown. Alcohol appears to increase the risk for AF, providing an opportunity to study electrophysiologic effects that may render the heart prone to arrhythmia. To identify acute changes in human atrial electrophysiology during alcohol exposure. We performed a randomized, double-blinded, placebo-controlled trial of intravenous alcohol titrated to 0.08% blood alcohol concentration versus a volume and osmolarity-matched, masked, placebo in patients undergoing AF ablation procedures. Right, left, and pulmonary vein atrial effective refractory periods (AERPs) and conduction times were measured pre- and post-infusion. Isoproterenol infusions and burst atrial pacing were used to assess AF inducibility. Of 100 participants (50 in each group), placebo recipients were more likely to be diabetic (22% v 4%, p=0.007) and to have undergone a prior AF ablation (36% v 22%, p=0.005). Pulmonary vein AERPs decreased an average of 12 ms (95% CI 1–22 ms, p=0.026) in the alcohol group, with no change in the placebo group (p=0.98). While no statistically significant differences in continuously-assessed AERPs were observed, the proportion of AERP sites tested that decreased with alcohol (median 0.5, IQR 0.6–0.6) was larger than with placebo (median 0.4, IQR 0.2–0.6, p=0.0043). No statistically significant differences in conduction times or in the proportion with inducible AF were observed. Acute exposure to alcohol reduces AERP, particularly in the pulmonary veins. These data demonstrate a direct mechanistic link between alcohol, a common lifestyle exposure, and immediate proarrhythmic effects in human atria. In this randomized, double-blinded, placebo-controlled study of intravenous alcohol titrated to 0.08%, alcohol resulted in a significant reduction in the pulmonary vein atrial effective refractory period and a greater proportion of sites exhibited a lower atrial effective refractory period with alcohol than with placebo. No changes in conduction times or differences in induced AF were observed. These findings demonstrate that alcohol acutely reduces atrial effective refractory periods, a phenomenon known to render atria more prone to fibrillate, providing the first mechanistic evidence that a common lifestyle factor can acute change cardiac electrophysiology to increase the chance of an arrhythmia.
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DOI：
10.1016/s0735-1097(83)80195-8
发表时间：
1983-01-01
影响因子：
24
作者：
ENGEL, TR;LUCK, JC
通讯作者：
LUCK, JC
影响因子：
39.2
作者：
GREENSPON, AJ;SCHAAL, SF
通讯作者：
SCHAAL, SF
DOI：
10.1111/j.1530-0277.2009.00906.x
发表时间：
2009-05-01
影响因子：
3.2
作者：
Ramchandani, Vijay A.;Plawecki, Martin;O'Connor, Sean
通讯作者：
O'Connor, Sean
影响因子：
2.8
作者：
Mandyam, Mala C.;Vedantham, Vasanth;Marcus, Gregory M.
通讯作者：
Marcus, Gregory M.
DOI：
10.1111/j.1521-0391.2011.00156.x
发表时间：
2011-09
期刊：
The American journal on addictions
影响因子：
--
作者：
Fillmore MT;Jude R
通讯作者：
Jude R