局灶性心房颤动的心电图特点

Electrocardiographic characteristics of focal atrial fibrillations

目的 :分析局灶性房颤的发作特点及临床意义。方法 :动态心电图监测分析经导管射频消融治疗证实为局灶性房颤患者 6 5例 ,以只有常见型的短阵房性心动过速患者 4 0例为对照组 ,统计单个房性早搏 (房早 )总数 ,房颤的发作时间、持续时间及发作次数 ,能够诱发房颤的房早 (包括直接诱发房颤和诱发房速或房扑转变成房颤 )的数量 ,房早的配对间期 (PP′)和早搏指数 (PI)。大于 1.5 s以上长间歇出现的例数 ,房颤发生前出现房早二联律的例数 ,房颤伴室内差异性传导例数。结果 :局灶性房颤组共记录到 4 97阵房颤 ,均由房早诱发 ,诱发房颤的房早均呈“P′on T”现象。诱发房颤房早的 PP′ 4 2 9± 96 ms,PI=0 .4 5± 0 .0 9;与诱发房颤的房早非同源的未诱发房颤的房早 PP′5 19± 88m s,PI=0 .5 5± 0 .12 ,两组房早 PP′比较有显著性差异 (P<0 .0 5 ) ,PI比较也有统计学差异 (P<0 .0 5 )。 6 5例患者房颤发作时均伴有室内差异性传导。 15例患者有房颤前发生房早二联律。 9例患者在房颤自然终止后出现>1.5 s的长间歇。对照组 4 0例动态心电图记录中均有常见型的短阵房速 ,引发房速的第 1个房早 PP′为 5 2 1± 85ms,PI=0 .6 2± 0 .15 ,与局灶性房颤组诱发房颤的房早 PP′和 PI比较有显著性差异 (P<0 .0 5 )。结?

AIM: To evaluate the characteristics of focal atrial fibrillation and their clinical significance. METHODS: In focal atrial fibrillation group(65 patients with focal atrial fibrillation proved by radiofrequency catheter ablation) and control group(40 patients with common atrial tachycardia), the following parameters were measured:total number of single atrial premature beats, number of times and lasting time of atrial fibrillation, number of atrial premature beats which evoked atrial fibrillation or atrial tachycardia and atrial flutter leading to atrial fibrillation, the coupling interval(PP′), prematurity index(PI), cases with long pause(>1.5 s), cases with atrial premature bigeminy before atrial fibrillation,and cases with intraventricular aberrant conduction in atrial fibrillation. RESULTS:In focal attrial fibrillation group, there were 497 outbreaks of atrial fibrillation. Atrial fibrillation were all evoked by atrial premature beats which were P′on T atrial premature beats. There were significant differences in PP′ and PI between atrial fibrillation evoked atrial premature beats and non atrial fibrillation evoked atrial premature beats (PP′: 428±96 ms vs 519±88 ms, P<0.05; PI:0.45±0.09 vs 0.55±0.12, P<0.05), respectively. There were intraventricular aberrant conductions accompanied by atrial fibrillation in 65 patients. There were atrial premature beats bigeminal rhythm in 15 patients and long pause(>1.5 s) after atrial fibrillation ending in 9 patients.In the control group, there were common short paroxysmal atrial tachycardia in all patients by dynamic electocardiogram analysis, and there were significant differences in PP′ of atrial tachycardia or atrial fibrillation evoked premature beats and PI, respectively. CONCLUSION:Focal atrial fibrillation is characterised with short period of outbreaeks of atrial fibrillation in day or night,with frequent atrial premature beats. The outbreaks of atrial fibrillation was evoled by P′ on T atrial premature beats with short PP′ period and low PI.