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目的研究普罗帕酮转复心房颤动(简称房颤)时左上肺静脉(LSPV)和左房(LA)外膜电图的变化,分析普罗帕酮转复房颤的可能机制。方法在6只山羊的LA前壁及LSPV根部外膜缝合电极片,LA快速刺激诱发房颤,在房颤自发维持超过24h后,静脉滴注普罗帕酮直至房颤终止。分析用药前、后房颤波周长(AFCL)分别延长40,80ms和房颤转复前各16s的间期内,LSPV和LA外膜电图的变化规律。结果6只山羊在经过静脉滴注普罗帕酮后,全部转复为窦性心律。用药前的LSPV的AFCL显著短于LA(P<0.05);用药后LSPV和LA的AFCL都出现逐渐延长,在房颤转复前两者趋于一致。用药前LSPV双电位和碎裂电位的百分比显著高于LA,单电位比例显著低于LA(P<0.05);用药后,LA和LSPV单电位百分比逐渐增加,双电位和碎裂电位逐渐减少,但在LA双电位和碎裂电位的比例始终小于LSPV(P<0.05);在房颤终止前LA先于LSPV出现双电位和碎裂电位的显著减少或消失,当LSPV的双电位和碎裂电位消失后房颤才终止。结论在本模型中,普罗帕酮对左房、肺静脉电生理的影响在房颤的转复过程中起着重要的作用。
Objective To investigate the changes of the left upper pulmonary vein (LSPV) and left atrium (LA) in the conversion of propafenone to atrial fibrillation (AF), and to analyze the possible mechanism of propafenone in ameliorating atrial fibrillation. Methods Electrodes were implanted on the anterior lobe of LA and the outer root of LSPV in 6 goats. AF was induced by LA and atrial fibrillation was induced. When propofol was maintained spontaneously for more than 24 hours, propafenone was intravenously administered until the termination of atrial fibrillation. Before and after treatment, the changes of perimeter electrocardiogram (LSPV) and LA (outer epicardial electrogram) of AF were prolonged by 40, 80 ms after atrial fibrillation (AFCL) and 16 s before atrial fibrillation (AF) respectively. Results Six goats were all converted to sinus rhythm after intravenous propafenone infusion. The AFCL of LSPV before treatment was significantly shorter than that of LA (P <0.05). Both AFCL of LSPV and LA were gradually prolonged after treatment, and both of them were consistent before AF. The percentage of bipotential and fragmentation potential of LSPV before treatment was significantly higher than that of LA, and the ratio of single potentials was significantly lower than that of LA (P <0.05). After treatment, the percentage of single potentials of LA and LSPV increased gradually, However, the ratio of bipolar potential to fragmentation potential in LA was always less than that in LSPV (P <0.05). Before LA, the potential and fragmentation potentials of LSP appeared to decrease or disappear before LSP termination. Atrial fibrillation disappeared after the termination of potential. Conclusions In this model, the effect of propafenone on left ventricular and pulmonary venous electrophysiology plays an important role in the process of atrial fibrillation.