地尔硫卓对心房急性电重构影响的临床研究

探讨地尔硫卓对心房快速激动诱发心房急性电重构的影响。将 31例导管射频消融成功的室上性心动过速患者随机分为两组 ,对照组 2 1例、地尔硫卓组 10例 ,以 15 0～ 2 0 0ms起搏周长 (PCL)诱发急性心房颤动 (AF)。以4 0 0msPCL分别在高位右房 (HRA)、低位右房 (LRA)、His束区 (HIS)等部位进行S1S2 扫描 ,测定基础状态、干预后和心房快速激动后心房有效不应期 (AERP) ;以三种不同PCL (35 0 ,4 0 0和 4 5 0ms)随机对右心耳 (RAA)进行S1S2 扫描 ,观察AERP频率自适应性的变化。对照组心房快速激动后HRA、LRA、HIS和RAA的AERP较基础状态、给盐水后有明显缩短 ;而地尔硫卓组心房快速激动后上述指标变化无显著性差异。将RAA处AERP与相应PCL进行曲线拟合 ,对照组基础状态下斜率为 0 .0 5 8、给盐水后斜率为 0 .0 6 8和心房快速激动后斜率为 0 .0 15。地尔硫卓组则分别为0 .0 30 ,0 .0 7和 0 .0 6 0。对照组诱发继发AF 13例 (13/2 1,6 1.9% ) ,明显高于地尔硫卓组 3例 (3/10 ,30 .0 % ) ,继发AF平均时限两组无明显差别。结论 :预先给予地尔硫卓可以阻止心房快速激动诱发的心房急性电重构的发生

The Effect of Diltiazem on Tachycardia-Induced Acute Atrial Electrical Remodeling in Human

Renming Hospital of Wuhan University,Wuhan 430060,China;Fujian Provincial Research Institute for Cardiovascular Diseases,Fuzhou 350001To investigate the effect of diltiazem on tachycardia induced acute atrial electrical remodeling in human.31 volunteer subjects with successful radiofrequency catheter ablation were randomly divided into control group and diltiazem group.Acute atrial fibrillation(AF) was induced in all subjects by a burst of rapid atrial pacing with a cycle length of 150 to 200 ms.The pre tachycardia,post drug and post tachycardia atrial effective refractory periods (ERP) were measured at a drive cycle length of 400 ms in multiple sites including high right atrium (HRA),low right atrium(LRA) and His bundle area (HIS).To determined the ERP adaptating to rate,the ERPs were measured in the right appendage(RAA) at 3 pacing cycle lengths (350,400,450 ms). The post tachycardia atrial ERPs in multi sites of HRA,LRA,HIS and RAA shortened significantly in control group,and did not changed dramatically in diltiazem group as compared with their corresponding post drug and pre tachycardia atrial ERP.Curve estimation showed that the pre tachycardia slope value was 0.058 in baseline,post saline 0.068 and post tachycardia 0.015 in control group,and which was 0.030,0.07 and 0.06 respectively in diltiazem group.Secondary AF occurred in 13 of 21 (61.9%) control subjects and 3 of 10 diltiazem subjects (30.0%, P <0.01,vs control group),no difference was found in mean duration of secondary AF between two groups.Conclusion:Pretreatment with diltiazem may prevent the tachycardia induced acute atrial electrical remodeling in human.