改善重构治疗对心房颤动者心房肌电生理特性的影响

目的]探讨阵发性心房颤动者血管紧张素Ⅱ1型受体(AT1)阻断剂(angiotensinⅡtype 1 receptorblockade,ARB)联合醛固酮受体阻断剂(aldosterone receptor antagonist,ARA)治疗前后心房内及房室结的电生理特性的差异,通过调搏刺激研究治疗前后心房颤动的诱发率.方法]联合ARB、ARA治疗98例阵发性心房颤动连续病例6个月,用食道-心房调搏技术对其治疗前后进行程序刺激并测定心传导系统的电生理差异.结果]窦律及基础起搏情况下治疗前后的房内传导及房室传导无统计学差别;早搏刺激下治疗前以心房有效不应期缩短、相对不应期延长、及房间传导时间延长为主要特点,与治疗后比较有显著性差异,提示血管紧张素Ⅱ1型受体阻断剂(ARB)联合醛固酮受体阻断剂(ARA)治疗后,心房有效不应期延长(P＜0.05)、相对不应期缩短(P＜0.05)及房间传导时间缩短(P＜0.05).同一组病例治疗后心房颤动的诱发率由原来的90%降至63%(P＜0.05).结论]心房有效不应期缩短、相对不应期延长、及房间传导时间延长为本组阵发性心房颤动患者治疗前的主要异常,联合血管紧张素Ⅱ1型受体阻断剂(ARB)、醛固酮受体阻断剂(ARA)治疗后,可能通过改善心脏电重构而纠正心房颤动患者的这些电生理异常,从而减少心房颤动的发生率.

Influence of Atrial and Atrial Ventricular Node on Electrophysiological Properties by Remodeling Treatment in Patients with Atrial Fibrillation

To explore the differentiation on electrophysiological properties of a trial and atrial ventricular node before a nd after 6months treatment by combin ation with angiotensin II type1receptor blockade(ARB)and aldosterone receptor antagonis t(ARA)therapy in the patients with paroxysmal atrial fibrillation,an d study on the onset of atrial fibrill ation inducing by electric pacing.The technique of esophagus-atrial program pacing was performed in 98con secutive patients with paroxysmal atrial fibrillatio n before and after 6months treatment by combination with ARB and ARA therapy.In the state of normal sinus rhythm an d in basic cycle length,the conduction function in atrial and A-V node had no different before and after treatmen t.The shortage of atrial effective refrectory period(ERP A )and the prolongation both atrial relative refrectory period(RRP A )and intra-atrial conduction delay(IACD)were the characteristic abnormalit y on electricity in the patients with paroxysmal atrial fib rillation using premature impulse.After 6months treatment the abnormality of shortage of ERP A and the prolongation both RRP A and IACD were mended significantly(P <0.05;P <0.05;P <0.05).Before treatment the initiation ra te of atrial fibrillation by esophagus-atrial pacing was 90%and after treatment was 63%(P <0.05).Conclusion]The characteristic abnormality on electrophysiological properties in the patients with paroxysmal atrial fibrillation was shortage of ERPA as well as the prolongation both RRPA an d IACD.The treatment in combination with ARB and ARA may reme dy electric remodeling and improve t his abnormality on electrophysiological properties a nd would not favor the onset of atrial fibrillation.