Background

postoperative atrial fibrillation (POAF) is a common cardiac surgery complication that is associated with increased complications and negative outcomes, but the association between presurgical atrial conduction abnormalities and POAF has not been investigated clinically during premature atrial S1S2 stimulation. This clinical study sought to examine whether intraoperative premature atrial stimulation reveals increased areas of slowed and/or blocked conduction in patients that develop POAF.

Methods

High-density intraoperative epicardial left atrial mapping was conducted in 20 cardiac surgery patients with no prior history of atrial fibrillation (AF). In 20 patients, 6 (30%) developed POAF. A flexible-array of 240-electrodes was placed on the posterior left atrial wall in between the pulmonary veins. Activation maps were generated for sinus and premature atrial S1S2 stimulated beats. The area of conduction block (CB), conduction delay (CD) and the combination of both (CDCB) for conduction velocity < 0.1, 0.1 ≤ x < 0.2 and < 0.2 m/s, respectively were quantified.

Results

For a premature atrial S2 beat with shortest cycle length captured, conduction velocity maps revealed a significantly higher area for CD (13.19 ± 6.59 versus 6.06 ± 4.22 mm², p = 0.028) and CDCB (17.36 ± 8.75 versus 7.41 ± 6.39 mm², p = 0.034), and a trend toward a larger area for CB (4.17 ± 3.66 versus 1.34 ± 2.86 mm², p = 0.063) in patients who developed POAF in comparison to those that remained in the sinus. Sinus and S1 paced beats did not show substantial differences in abnormal conduction areas between patients with and without POAF.

Conclusion

In comparison to sinus and S1 beats, premature atrial S2 beats accentuate conduction abnormalities in the posterior left atrial wall of cardiac surgery patients that developed POAF.

中文翻译：

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过早的心房刺激会加重心脏手术患者发生术后心房颤动的传导异常

背景

术后心房颤动 (POAF) 是一种常见的心脏手术并发症，与并发症增加和不良结果相关，但术前心房传导异常与 POAF 之间的关联尚未在早发心房 S1S2 刺激期间进行临床研究。本临床研究旨在检查术中过早心房刺激是否揭示了发生 POAF 的患者传导减慢和/或传导受阻的面积增加。

方法

对 20 名没有房颤 (AF) 病史的心脏手术患者进行了高密度术中心外膜左心房标测。在 20 名患者中，6 名 (30%) 发展为 POAF。一个由 240 个电极组成的柔性阵列被放置在肺静脉之间的左心房后壁上。为窦性和早发心房 S1S2 刺激搏动生成激活图。分别对传导速度 < 0.1、0.1 ≤ x < 0.2 和 < 0.2 m/s 的传导阻滞面积 (CB)、传导延迟 (CD) 和两者的组合 (CDCB) 进行量化。

结果

对于捕捉到的最短周期长度的早发心房 S2 搏动，传导速度图显示 CD（13.19 ± 6.59 对 6.06 ± 4.22 mm 2 ，p = 0.028）和 CDCB（17.36 ± 8.75 对^7.41 ± 6.39  mm ²，p = 0.034)，并且 与留在鼻窦中的患者相比，发生 POAF 的患者的 CB 面积趋于更大（4.17 ± 3.66 对 1.34 ± 2.86 mm ²，p = 0.063）。窦性和 S1 起搏的搏动在有和没有 POAF 的患者之间的异常传导区域没有显示出实质性差异。

结论

与窦性和 S1 搏动相比，房性 S2 早搏加重了发生 POAF 的心脏手术患者左心房后壁的传导异常。