Left atrial pacing induces memory and is associated with atrial tachyarrhythmias
Left atrial pacing induces memory and is associated with atrial tachyarrhythmias
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DOI：
10.1016/s0008-6363(03)00536-4
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发表时间：
2003-11-01
影响因子：
10.8
通讯作者：
Rosen, MR
中科院分区：
文献类型：
--
作者：
Chandra, P;Rosen, TS;Rosen, MR
目的：瞬时改变心房激动序列可诱导心房记忆，表现为心电图XYZ导联测量的心房梯度改变。我们假设左心房冲动起始时间延长改变心房梯度，这是心律失常的一种预测方式。研究方法：对12只慢性内固定的完全性心脏传导阻滞杂种犬，从左或右心房依次进行房室起搏7-28天，然后恢复正常窦性心律21天。记录整个期间的频率直方图，并进行电生理研究以记录心房梯度、有效不应期和心房节律的变化。在8只植入器械但未起搏的对照动物中未观察到房性心律失常。结果如下：左心房起搏与心房梯度降低和起搏期间出现并在起搏恢复期间持续存在的房性心动过速的发生相关。相比之下，右心房起搏没有显著改变心房梯度。当犬恢复窦性心律时，右心房起搏期间发生的房性心动过速在起搏停止后消失。两组的有效不应期均未发生变化。结论：起搏诱导的左心房脉冲起始改变了心房梯度，并与房性心动过速相关。这些心房梯度的变化发生在没有ERP变化的情况下，可能是致心律失常底物的早期预测因子。(C)2003年欧洲心脏病学会。Elsevier B. V.出版，保留所有权利。
Objective: Transiently altering the atrial activation sequence induces atrial memory, manifested as an altered atrial gradient as measured in electrocardiographic XYZ leads. We hypothesized that protracted periods of left atrial impulse initiation alter the atrial gradient in a manner predictive of arrhythmias. Methods: A total of 12 chronically instrumented mongrel dogs in complete heart block were paced AV sequentially from the left or right atrium for 7-28 days, and then recovered in normal sinus rhythm for 21 days. Rate histograms were recorded during the entire period, and electrophysiological studies were conducted to note changes in the atrial gradient, effective refractory period and atrial rhythm. No atrial arrhythmias were seen in eight control animals that were instrumented but not paced. Results: Left atrial pacing was associated with a decreased atrial gradient and occurrence of atrial tachycardias that appeared during pacing and persisted during recovery from pacing. In contrast, right atrial pacing did not alter the atrial gradient significantly. Atrial tachycardias occurring during right atrial pacing disappeared after cessation of pacing, when dogs recovered in sinus rhythm. The effective refractory period did not change in either group. Conclusions: Pacing-induced impulse initiation from the left atrium alters the atrial gradient and is associated with atrial tachycardias. These changes in atrial gradient occur in the absence of ERP changes and may be early predictors of an arrhythmogenic substrate. (C) 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.