A temporal window of vulnerability for development of atrial fibrillation with advancing heart failure
A temporal window of vulnerability for development of atrial fibrillation with advancing heart failure
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DOI：
10.1002/ejhf.28
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发表时间：
2014-03-01
影响因子：
18.2
通讯作者：
Antzelevitch, Charles
中科院分区：
文献类型：
--
作者：
Burashnikov, Alexander;Di Diego, Jose M.;Antzelevitch, Charles
目的心力衰竭（HF）与AF和危及生命的室性心动过速和室颤（VT/VF）的发生有关。在HF的不同阶段发展AF和VT/VF的脆弱性和潜在的病理生理机制尚不清楚。本研究的目的是确定发展的时间过程中的电和结构重塑的心房和心室，和他们的贡献，诱导AF和VT/VF在犬模型HF.Methods和resultsDogs室性心动过速（VTP）为2-3周或5-6周（“早期”和“晚期”HF，分别）。在离体心房和心室制备中进行电生理研究，并与体内记录的心脏尺寸和血液动力学参数相关。HF早期与晚期相比，程控电刺激诱发AF的脆弱性更大（78%与38%）。相比之下，VT/VF在HF晚期可诱导，但在早期不可诱导（38% vs. 0%）。房性和室性心律失常易感性的时间差异与心房电重构和结构重构的更快发展相关。AF的脆弱性开发后中度电结构重塑和减弱，进一步发展到严重的重塑，避免快速心房activation.ConclusionsA时间窗口的脆弱性AF出现相对较早的发展过程中VT诱导的HF在狗，而VT/VF的脆弱性，观察到在更先进的阶段HF。这些发现，如果在人类中得到证实，可能对HF患者的预后和治疗方法具有临床意义。
AimsHeart failure (HF) is associated with development of AF and life-threatening ventricular tachycardia and fibrillation (VT/VF). Vulnerability to development of AF and VT/VF at different stages of HF and the underlying pathophysiological mechanisms are poorly defined. The present study was designed to determine the time-course of development of electrical and structural remodelling of the atria and ventricles, and their contribution to induction of AF and VT/VF in a canine model of HF.Methods and resultsDogs were ventricular tachypaced (VTP) for 2-3 weeks or 5-6 weeks ('early' and 'late' HF, respectively). Electrophysiological studies were performed in isolated atrial and ventricular preparations and correlated with cardiac dimensions and haemodynamic parameters recorded in vivo. Vulnerability to programmed electrical stimulation-induced AF was greater in early vs. late stages of HF (78% vs. 38%). In contrast, VT/VF was inducible in late but not in early stages of HF (38% vs. 0%). The temporal distinction in atrial and ventricular arrhythmia susceptibility was associated with a much more rapid development of electrical and structural remodelling in atria. Vulnerability to AF developed following moderate electro-structural remodelling and waned with further progression to severe remodelling, which averted rapid atrial activation.ConclusionsA temporal window of vulnerability for AF appears relatively early during development of VTP-induced HF in dogs, whereas VT/VF vulnerability is observed at more advanced stages of HF. These findings, if confirmed in humans, may have clinical implications with regard to prognosis and approach to therapy of patients with HF.