阵发性心房颤动后心跳长间歇与窦房结恢复时间的关系及肺静脉隔离对其影响

目的 检测由于阵发性心房颤动反复发作导致心跳长间歇患者的窦房结恢复时间(SNRT),并分析肺静脉隔离对其影响. 方法 11例接受导管射频消融治疗的阵发性心房颤动患者,在4支肺静脉口外进行节段性肺静脉隔离,分析心跳长间歇与160次/min心房刺激测得的SNRT(SNRT160)及模拟心房颤动600次/min测得的SNRT(SNRT600)的关系及肺静脉隔离前后SNRT160及SNRT600的差异. 结果 11例患者均成功隔离所有肺静脉.12导联心电图或动态心电图提示与症状相关的心跳长间歇为(3464±918)ms.肺静脉隔离前测定的SNRT160为(1655±378)ms,SNRT600为(1682±419)ms;肺静脉隔离后测定的SNRT160为(1491±284)ms,SNRT600为(1518±218)ms.SNRT160及SNRT600肺静脉隔离前后比较差异无统计学意义.心跳长间歇与肺静脉隔离前后SNRT无相关性. 结论 阵发性心房颤动终止后发生的心跳长间歇与病态窦房结综合征所致的心跳长间歇的发生机制可能不尽相同.肺静脉隔离是治疗阵发性心房颤动诱发心跳长间歇安全有效的方法.

The relationship of long-pause after atrial fibrillation termination and sinus nodal recovery time and impact of pulmonary vein isolation on it

Objective To analyze the relationship of long-pause after atrial fibrillation termination and sinus nodal recovery time(SNRT)and impact of pulmonary vein isolation on it in order to disclose the potential mechanism of long-pause after atrial fibrillation and to discussthe optional therapy for this kind of long-pause.Methods Eleven patientswith syncope or presyncope because of long-pause after paroxysmal atrial fibrillation termination were involved in this study.Segmental pulmonary veins isolation wag performed.SNRT160 and SNRT600 were measured by ahial stimulation at S1S1 160 heats/min and 600 beats/min for one minute before and after pulmonary vein isolation.Results All pulmonary vein isolation was achieved in 11 patients.Seven patients were free of atrial fibrillation and syncope or presyneope during mean(13±7)months'follow-up.Permanent pacemaker wag implanted in 2 patients because of syncope or presyncope resulting from long-panse demonstrated by electrogram.The other 2 patients with recurrence of atrial fibrillation were still in follow-up without any antiarrhythmic drugs because of long-pause.The long-pause was(3464±918)ms before ablation.SNRT160 was(1655±378)ma and(1491±284)ma before and after ablation.SNRT600 was(1682±419)ms and(1518±218)ms before and after ablation.There was no significant difference of SNRT before and after pulmonary vein isolation.No significant relalionship between long-pause and SNRT was observed.Conclusions Eradication of paroxysmal atrial fibrillation by pulmonary vein isolation is effective treatment for long-pause resulting from atrial fibrillation termination.Sinus nodal malfunction may be not contribute to the long-pause resulting from paroxysmal atrial fibrillation.