Action potential duration restitution kinetics in human atrial fibrillation
Action potential duration restitution kinetics in human atrial fibrillation
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DOI：
10.1016/s0735-1097(02)01760-6
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发表时间：
2002-04-17
影响因子：
24
通讯作者：
Ro, YM
中科院分区：
文献类型：
--
作者：
Kim, BS;Kim, YH;Ro, YM
目的我们进行这项研究是为了确定人类心房颤动（AF）是否与急剧倾斜的动作电位时程恢复（APDR）动力学有关，以及APDR的空间不均匀性是否促进AF的持续性。背景已知急剧倾斜的APDR曲线是诱导更复杂的动作电位时程（APD）动力学和颤动的重要决定因素。方法慢性心房颤动患者（研究对象包括阵发性心房颤动（PAF）组（n = 14）、阵发性心房颤动（CAF）组（n = 18）和正常对照组（n = 9）。在右心房6个部位测量了90%复极时相动作电位时程（APD（90））和有效不应期（ERP）。结果CAF患者的APD（90）和ERP均明显短于PAF患者和正常对照组，APD 90和ERP均明显短于PAF患者和正常对照组，APD 90和ERP均明显低于PAF患者和正常对照组而APD（90）和ERP离散度各组间无显著差异（P> 0.05）。CAF（1.2 +/- 0.4和1.7 +/- 0.2）和PAF（1.1 +/- 0.4和1.3 +/- 0.4）患者的S、S和快速起搏的APDR最大斜率高于对照组（分别为0.5 +/- 0.3和0.8 +/- 0.2; p < 0.01）。由S.与任何组中快速起搏获得的结果均无差异。CAF患者最大斜率的区域间差异（1.6 ± 0.4，p < 0.05）大于PAF患者（1.2 ± 0.3，p = NS vs. control）和对照组（0.4 ± 0.2）。慢性AF患者APDR的空间离散度大于阵发性AF患者和对照受试者，表明心房APDR的异质性在AF的持续性中起重要作用（J Am科尔Cardiol 2002;39：1329-36）（C）2002 by the American College of Cardiology Foundation。
OBJECTIVES We undertook this study to determine whether human atrial fibrillation (AF) relates to steeply sloped action potential duration restitution (APDR) kinetics and whether the spatial nonuniformity of APDR promotes persistence of AF.BACKGROUND A steeply sloped APDR curve is known to be an important determinant of the induction of more complex action potential duration (APD) dynamics and fibrillation.METHODS Patients with chronic atrial fibrillation (CAF) (n = 18), paroxysmal atrial fibrillation (PAF) (n = 14) and normal control subjects (n = 9) were studied. The monophasic action potential duration at 90% repolarization (APD(90) and the effective refractory period (ERP) were measured at six sites in the right atrium. After AF was electrically converted, APDR was assessed by delivering a single extrastiniulus after a train of stimuli at a cycle length of 600 ms (S1S2) at six different sites of the right atrium, as well as rapid pacing at cycle lengths that induced APD alternans.RESULTS The APD(90) and ERP in patients with CAF were shorter than those in patients with PAF and control subjects (p < 0.05); however, the dispersions of APD(90) and ERP in each group were similar. The maximal slopes of APDR by S,S, and rapid pacing in patients with CAF (1.2 +/- 0.4 and 1.7 +/- 0.2) and PAF (1.1 +/- 0.4 and 1.3 +/- 0.4) were higher than those in control subjects (0.5 +/- 0.3 and 0.8 +/- 0.2, respectively; p < 0.01). The maximal slope obtained by,S. did not differ from that obtained by rapid pacing in any group. The inter-regional difference of the maximal slope in patients with CAF (1.6 +/- 0.4, p < 0.05) was greater than that in patients with PAF (1.2 0.3, p = NS vs. control) and control subjects (0.4 +/- 0.2).CONCLUSIONS Atrial fibrillation was related to steeply sloped (>1) APDR kinetics. The spatial dispersion of APDR in patients with chronic AF was greater than that of patients with paroxysmal AF and control subjects, indicating that the heterogeneity of APDR of the atriums plays an important role in the persistence of AF. (J Am Coll Cardiol 2002;39:1329-36) (C) 2002 by the American College of Cardiology Foundation.