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心房颤动电重构的研究进展 总被引:3,自引:3,他引:0
心房颤动(AF)是临床上常见的快速室上性心律失常之一,在人群中发病率较高,并发症较多,疗效欠佳。因此需要更深刻地认识AF的发生机制,下面就近年来AF的电重构研究进展作一综述。1 AF电重构的提出 在过去的近一个世纪中,人们对AF的电生理机制的认识经历了一个逐步深入的过程。从不被实验支持的异位自律灶学说到Moe假说即多发小波随机折返学说,从核心折返环学说到自旋波折返学说,折返机制在AF发生与维持中的作用已为绝大多数学者所认同。近十年来,人们观察到AF具有自身延续性(selfperpetuating),即AF自身呈现为一种进展性疾病,其证… 相似文献
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心房颤动引起心房电重构机制的研究进展 总被引:1,自引:0,他引:1
1 引言心房颤动 (简称房颤 )能引起心房电生理功能的改变 ,促使房颤的发生和维持 ,这一过程通常称之为“心房电生理重构”(简称电重构 )。电重构是 1995年由Wijffels等提出 [1]。他们给山羊安装一种起搏装置 ,通过对两心房的超速起搏 (>4 0 0次 /分 [BPM]) ,发现超速起搏可诱发房颤 ,而且随着刺激时间的延长 ,房颤的持续时间也延长 ,这就是“房颤致房颤”理论的来源。很久以前临床医生就发现房颤的自然病程常由自发性向持续性转变 ,暗示了房颤的发生能改变心房特性 ,从而增加了持续心律失常的可能性 ,Wijffels等称之为“房颤的驯化”(Do… 相似文献
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心房颤动是一种十分常见的心律失常,随年龄增长发病率增加。在心房颤动的发生机制中,心房电重构起着重要作用。本文就心房电重构的离子分子基础、钙离子机制在心房电重构发生和维持中的作用以及老龄对心房电重构影响的现阶段研究进展予以综述。 相似文献
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心房颤动(房颤)时心房电生理重构和解剖重构在房颤的发生、发展中发挥重要作用,大量研究结果提示,快速心房激动时从细胞、离子通道及分子水平均发生了明显改变,其中细胞内Ca2+超载、钙电流(IcaL)、外向钾电流的变化以及通道mRNA和蛋白质表达水平的变化是心房重构的主要因素。细胞氧化和炎症介质等在心房重构中的作用日益受到重视。 相似文献
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心房颤动是人类最为常见的快速型心律失常,而心房电重构在心房颤动的发生和维持中起着重要的作用。目前,国内外学者对心房电重构的机制进行了许多先进的研究,认为心房电重构主要是由离子通道重构引起,同时也可能和心房肌钙超载、肾素-血管紧张素系统及其他有关。本文对此机制进行了全面的综述。 相似文献
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The Role of Atrial Electrical Remodeling in the Progression of Focal Atrial Ectopy to Persistent Atrial Fibrillation 总被引:3,自引:0,他引:3
W. JULIAN C. HOBBS M.B. ISABELLE C. Van GELDER M.D. † ADAM P. FITZPATRICK M.D. HARRY J.G.M. CRIJNS M.D. † CLIFFORD J. GARRATT M.D. 《Journal of cardiovascular electrophysiology》1999,10(6):866-870
Although atrial fibrillation- (AF) induced changes in atrial refractoriness (atrial electrical remodeling) have been demonstrated in a number of different animal models, the clinical significance of this process is unknown. We describe a patient in whom there has been documented progression of atrial ectopy to persistent AF accompanied by evidence of atrial electrical remodeling, with reversal of remodeling following successful ablation of the focal source of AF. A second patient with focal AF, but with a "nonfocal" appearance on the ECG, is also described. These cases illustrate: (1) the possibility that a significant proportion of younger patients with idiopathic persistent AF may well have a focal source as the underlying abnormality; and (2) atrial electrical remodeling reverses following ablation of the underlying source. 相似文献
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随着心房颤动电生理机制研究的广泛深人,已经认识到离子通道重构在心房颤动的发生和维持过程中起重要作用。L-型钙通道及其基因表达的改变可能是老年人容易发生心房颤动电生理重建的离子和分子基础。现就心脏钙离子通道及年龄与心房颤动的研究进展予以综述。 相似文献
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心房颤动是临床上最常见的心律失常之一,有较高的发病率、致残率,严重影响患者的生活质量。但是关于心房颤动的发病机制至今并未完全明确,目前对其结构重构的发生机制研究较多,包括钙离子超载、心肌局部肾素-血管紧张素系统激活、基质金属蛋白酶改变、缝隙连接蛋白改变等。同时,针对导致心房颤动结构重构的可能机制,出现了一些新的预防和治疗心房颤动策略。现就心房颤动结构重构的发病机制研究及相应治疗进展做一综述。 相似文献
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比较快速心房起搏与急性心房颤动 (简称房颤 )诱发心房电生理特性的变化。以 15 0~ 2 0 0ms起搏周长(PCL)对 4 5例成功射频消融后 (RFCA)病人右房进行S1S1刺激诱发急性房颤 ,据能否诱发急性房颤分为非房颤组和急性房颤组 ;再以 4 0 0msPCL对心房快速激动前后高位右房、低位右房、His束周围等多部位进行S1S2 扫描 ,测定心房有效不应期 (ERP)、ERP离散度 (ERPd)、右房内及房间的传导时间的变化 ;另以 35 0 ,4 0 0和 4 5 0ms三个PCL随机对RAA进行S1S2 扫描 ,观察ERP频率自适应性的变化。两组心房快速激动后 4 0 0msPCL下右房各刺激部位及三种不同PCL右心耳ERP均较心房快速激动前有明显的缩短 ,并且缩短的程度相同。两组病人心房快速激动前后房内和房间传导时间及ERPd没有明显改变。两组心房快速激动前后斜率均值均较激动后明显下降 ;心房快速激动前、后斜率均值两组间无显明差别 (P >0 .0 5 )。结论 :两种方式的心房快速激动可诱发相似的心房电重构现象。 相似文献
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CLIFFORD J. GARRATT D.M. MATTIAS DUYTSCHAEVER M.D. MATTHUS KILLIAN Ph .D. RICK DORLAND B.S. FRANS MAST Ph .D. MAURITS A. ALLFSSIE M.D. Ph .D. 《Journal of cardiovascular electrophysiology》1999,10(8):1101-1108
INTRODUCTION: Episodes of atrial fibrillation (AF) are known to cause both a rapid reduction in atrial refractoriness (atrial electrical remodeling) and a more delayed increase in AF stability in the chronic goat model. The aims of this study were to examine (1) the hypothesis that an AF-induced increase in AF stability might be due to a mechanism with a longer onset and offset than that of changes in refractoriness and (2) the possibility that repeated paroxysms of maintained AF might cause a cumulative increase in AF stability independent of changes in atrial refractoriness. METHODS AND RESULTS: AF was maintained by rapid atrial pacing in seven goats for three consecutive 5-day periods, each separated from each other by 48 hours of sinus rhythm. Assessments of atrial refractory periods, conduction velocity, AF inducibility, and duration of individual episodes of AF were attempted at intervals throughout the protocol. Forty-eight hours of sinus rhythm was just sufficient for refractoriness changes to fully reverse in all goats, with no evidence of any "residual" increase in AF inducibility. There was no significant difference among any of the three periods of pacing-maintained AF with regard to time to develop episodes of AF of 60-second duration (22.1+/-13, 23.8+/-16, and 30.3+/-29 hours), 1-hour duration (56.6+/-28, 61.3+/-31, and 60.1+/-32 hours), or 24-hour duration (84.0+/-31, 87.0+/-33, and 83.5+/-32 hours). CONCLUSION: There is no evidence for a cumulative effect of AF paroxysms on AF inducibility or stability independent of changes in refractoriness. These findings highlight the importance of atrial refractoriness as a potential target for antiarrhythmic strategies aimed at inhibiting the self-perpetuation of AF. 相似文献
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心房颤动是常见的心律失常,随年龄的增长发病率逐渐的增加。在心房颤动的发生机制中,心房结构重构起着重要的作用,现就基质金属蛋白酶及抑制因子在心房结构重构中的作用以及老龄对心房结构重构影响的现阶段研究进展予以综述。 相似文献
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心房颤动患者心房纤维化研究进展 总被引:1,自引:0,他引:1
心房颤动的发生和维持与心房重构有关。心房纤维化是心房颤动患者心房结构重构最突出的表现,目前被认为是发生心房颤动的结构基础,是心房颤动发生、维持的一个重要因素。现综述心房颤动患者心房纤维化及其发生机制。通过对心房颤动患者心房纤维化结构改变及肾素-血管紧张素系统、转化生长因子、基质金属蛋白酶等在心房纤维化的发生和心房颤动发生、维持中的作用等的全面阐述,,探讨了心房颤动患者心房纤维化的研究进展。防治心房颤动新的策略取决于对心房纤维化机制更好的理解。 相似文献
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CAROLINE MEDI B. MED. ANDREW W. TEH M.B.B.S. Ph.D. KURT ROBERTS‐THOMSON M.B.B.S. Ph.D. JOSEPH B. MORTON M.B.B.S. Ph.D. PETER M. KISTLER M.B.B.S. Ph.D. JONATHAN M. KALMAN M.B.B.S. Ph.D. 《Journal of cardiovascular electrophysiology》2012,23(10):1067-1072
Atrial Remodeling in Atrial Flutter. Introduction: Atrial fibrillation (AF) and atrial flutter (AFL) are related arrhythmias with common triggers, yet in individual patients either AF or AFL often predominates. We performed detailed electrophysiologic (EP) and electroanatomic (EA) studies of the right atrium (RA) in patients with AF and AFL to determine substrate differences that may explain the preferential expression of AF/AFL in individual patients. Methods: Patients with AF (n = 13) were compared to patients with persistent AFL (n = 10). Detailed studies were performed, and 3‐dimensional electroanatomic mapping studies were created and the RA was divided into 4 segments for regional analysis. Global, septal, lateral, anterior, and posterior segments were compared for analysis of: bipolar voltage; proportion of low‐voltage areas and areas of electrical silence; conduction times; and proportion of abnormal signals (fractionated signals and double potentials). Results: Compared to patients with AF, patients with AFL had (1) lower bipolar voltage and an increase in the proportion of low‐voltage areas; (2) an increase in the proportion of complex signals; and (3) prolongation of activation times. Conclusions: Patients with AFL showed more advanced remodeling than patients with AF with slowed conduction, lower voltage areas with regions of electrical silence, and a greater proportion of complex signals, particularly in the posterior RA. These changes facilitate the stabilization of AFL and may explain why some patients are more likely to develop AFL as a sustained clinical arrhythmia. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1067‐1072, October 2012) 相似文献