阵发性心房颤动心房电激动频谱图中固定非主频成分的意义.DOC

阵发性心房颤动心房电激动频谱图中固定非主频成分的意义 张海波 龙毅 黄正林 （雅安市人民医院心内科，四川 雅安 625000 ） 摘要 背景 心房颤动(房颤)时, 心房电激动信号频谱分析中频谱非主频成分产生机制被认为主要由于颤动样传导导致. 然而, 也可能存在其它机制. 目的 本研究拟通过建立犬乙酰胆碱诱导的阵发性房颤模型, 探讨非主频成分在阵发性房颤中的其它可能机制. 方法 于20只犬中建立乙酰胆碱诱导的阵发性房颤模型. 分为2组, 每组10犬. 组1于左上肺静脉脂肪垫附近注射乙酰胆碱, 组2右上肺静脉附近脂肪垫注射乙酰胆碱. 进行心房Burst刺激后诱导阵发性房颤, 于房颤时, 对左, 右肺静脉附近及左心房中部位点进行电激动图标测. 进一步对组1, 组2行环肺静脉电隔离射频消融. 分别于环左肺静脉电隔离后, 环右肺静脉电隔离后, 对以上部位进行电激动图标测. 并对电激动时域图进行频谱分析. 结果 20只犬经乙酰胆碱加Burst刺激均诱发出阵发性房颤. 组1中, 9犬于左房中部位点的电激动频域图上观察到1个固定非主频成分. 该非主频成分频率与左上肺静脉附近电激动频率相同(9±0.4 vs. 9±0.4, P0.05). 组2中, 7犬于左房中部位点的电激动频域图上观察到1个固定非主频成分. 该固定非主频成分频率与右上肺静脉附近电激动频率相同(8.4 ±0.3 vs. 8.4 ±0.3, P0.05.). 环左肺静脉电隔离后, 组1中的固定非主频成分消失, 但组2中的固定非主频成分不变. 再次行环右肺静脉电隔离后, 组2中的固定非主频成分也消失. 结论 阵发性房颤时, 心房电激动图频谱分析中频谱图上的固定非主频成分可反映房颤的触发灶. 关键词: 房颤; 频谱分析; 消融. The fixed frequency spectral component may reflect the drivers of the paroxysmal atrial fibrillation. Abstract Background Mechanisms of frequency spectral components were not clear. Aims To investigate the mechanisms of frequency spectral components in paroxysmal atrial fibrillation. Methods Ach induced paroxysmal atrial fibrillation was induced in 20 dogs, which were divided into 2 groups. In group 1, Ach was injected into the fat pad near the left superior pulmonary vein. In group 2, Ach was injected into the fat pad near the right superior pulmonary vein. Burst stimulation was performed after Ach injection. Electrograms of atrium during atrial fibrillation were recorded and were analyzed by spectral analysis. Results Paroxysmal atrial fibrillation was induced in each dog. In group 1, fixed frequency spectral component was noted in 9 dogs. The frequency of the component was equal to the dominant frequency of the left superior pulmonary vein(9?.4 vs. 9?.4, P0.05). In group 2, fixed frequency spectral component was noted in 7 dogs. stThe frequency of the component was equal to the dominant frequency of the right superior pulmonary vein (8.4 ?.3 vs. 8.4 ?.3, P0.05.). After left eqsuperior pulmonary vein isolation, the fixed