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目的:分析不同部位起源,不同联律间期房性期前收缩对心房有效不应期(ERP)、房内传导时间(CT)及波长(WL)的影响,探讨短联律间期房性期前收缩诱发心房颤动的电生理机制。方法:选自2006-04-2008-02期间25例无器质性心脏病室上性心动过速患者,程控刺激高右房(HRA),冠状窦远端(CSd),测出上述2个部位基础刺激时(500ms)心房ERP及HRA←CSd的CT。保持基础刺激不变,分别给予不同联律间期的S2期前收缩刺激(S1S1不应期+20ms,+70ms,+120ms,+170ms),测出不同期前收缩刺激后心房ERP及HRA←CSd的CT。分别对基础及不同期前收缩刺激后心房ERP,CT及WL的变化以及HRA,CSd上述刺激时各项指标的变化进行分析。结果:联律间期短的期前收缩刺激较之联律间期长者使心房ERP明显缩短(P<0·05),CT明显延长(P<0·05),WL明显缩短(P<0·05),联律间期相同而起源部位不同的房性期前收缩对心房ERP、CT及WL的影响无差别(P>0·05)。结论:短联律间期房性期前收缩可使心房ERP缩短,房内传导时间延长,WL缩短,为心房颤动形成提供了电生理基础。
OBJECTIVE: To analyze the effect of different parts of origin, different syndromic atrial contraction on atrial effective refractory period (ERP), conduction time (CT) and wavelength (WL) Contractive induced electrophysiological mechanisms of atrial fibrillation. Methods: Twenty-five patients with supraventricular tachycardia who had no organic heart disease selected from 2006-04-2008-02 were enrolled in this study. The high right atrium (HRA) and distal coronary sinus (CSd) Basal stimulation (500ms) atrial ERP and HRA ← CSd CT. To maintain the basic stimulation unchanged, respectively, given different syndrom between the pre-S2 contraction stimulation (S1S1 refractory period +20 ms, +70 ms, +120 ms, +170 ms), measured at different stages after atrial contraction stimulated ERP and HRA ← CSd’s CT. The change of atrial ERP, CT and WL after contracting stimulation and the changes of each index when HRA and CSd were stimulated were analyzed respectively. Results: Short systolic short-term systolic stimulation significantly shortened atrial ERP (P <0.05), prolonged CT (P <0.05) and shortened WL (P < 0.05). There was no significant difference in atrial ERP, CT and WL between atrial septum and anterior atrial septum with the same interval but different origins (P> 0.05). CONCLUSIONS: Short-term inter-systolic atrial systolic shortening shortens atrial ERP, prolongs conduction time in the atrium and shortens WL, providing an electrophysiological basis for the formation of atrial fibrillation.