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目的 :测定风湿性心脏病并心房颤动 (Af)患者心房及肺静脉的有效不应期 (ERP) ,探讨其电生理特点。方法 :6例持续性Af患者术前 2～ 3周予抗凝治疗 ,术前 7d予胺碘酮转复 ,1例转复成功 ,另 5例经同步直流电转复治疗 ;3例阵发性Af患者术前未予以抗凝和药物转复治疗。 9例患者均行二尖瓣球囊扩张术 ,术后行电生理检查 ,标测肺静脉尖峰电位并测定左、右心房及肺静脉ERP。结果 :9例患者均可在肺静脉内标测到肺静脉电位。 9例患者的右房、左房、左上肺静脉平均ERP分别为 (2 12 .2 2± 30 .73)ms、(2 5 7.78± 33.4 6 )ms、(2 5 2 .2 2±4 2 .36 )ms ;5个左下肺静脉ERP(2 4 0 .0 0± 5 3.39)ms;平均肺静脉ERP(2 4 2 .5 0± 4 8.6 2 )ms。右房ERP比左房的短 ,右房ERP比左上肺静脉的短 (P值分别为P <0 .0 1、P <0 .0 5 )。 12个Af起源点的ERP为 (2 15 .0 0± 5 3.70 )ms,而 2 4个非Af起源点的ERP为 (2 4 8.33± 35 .77)ms,Af起源点的ERP较短 (P <0 .0 5 )。结论 :风湿性心脏病患者肺静脉内可以记录到肺静脉电位 ,Af起源点的ERP较非Af起源点部位的ERP短
AIM: To determine the effective refractory period (ERP) of atrial and pulmonary veins in patients with rheumatic heart disease and atrial fibrillation (Af) and to investigate their electrophysiological characteristics. Methods: Six patients with persistent Af were treated with anticoagulation therapy 2 to 3 weeks before operation. Amiodarone was given 7 days before operation. One case recovered successfully and the other 5 cases were treated by synchronous DC. Three patients with paroxysmal Af No anticoagulant and drug treatment before surgery. Nine patients underwent mitral balloon dilatation. Postoperative electrophysiological examination was performed to measure the spiking potential of the pulmonary vein and determine the left and right atrium and pulmonary vein ERP. Results: All the 9 patients were detected pulmonary venous potential in the pulmonary vein. The average ERP of right atrium, left atrium and left upper pulmonary vein of 9 patients were (2 12.22 ± 30.73) ms, (2 5 7.78 ± 33.4 6) ms, (2 52.2 ± 42) ms respectively. 36) ms; 5 left lower pulmonary veins ERP (240.00 ± 5 3.39) ms; mean pulmonary veins ERP (224.5 ± 0.4682) ms. ERP of the right atrium was shorter than that of the left atrium and ERP of the right atrium was shorter than that of the left upper pulmonary vein (P <0.01, P <0.05, respectively). The ERPs of 12 Af origin sites were (21 15.0 ± 5 3.70) ms, while the ERPs of 24 non-Af origin sites were (24.33 ± 35.77) ms, and the ERPs of Af origin sites were shorter P <0. 05). Conclusion: Pulmonary venous potential can be recorded in the pulmonary veins of patients with rheumatic heart disease. ERP of origin of Af is shorter than that of non-Af origin