阵发性心房颤动的动态心电图分析

Analysis of ambulatory electrocardiogram of paroxysmal atrial fibrillation

目的探讨动态心电图对阵发性心房颤动诊断和疗效判断的意义。方法分析78例阵发性心房颤动患者和80例对照组的24h动态心电图。统计单个期前收缩总数、心房颤动的频率和持续时间、心房颤动相关的偶联间期、非心房颤动患者房性期前收缩的偶联间期及24h房性期前收缩总数。结果心房颤动组:共发作33314阵心房颤动,其中36例11173阵发生在8∶00至22∶00,74例22141阵发生在22∶00至8∶00。平均24h房性期前收缩8242±1245个,心房颤动456±122阵。诱发心房颤动的,17例为单一房性期前收缩的偶联间期,33例为两种房性期前收缩的偶联间期,28例为两种以上房性期前收缩的偶联间期。发作前与发作相关的房性期前收缩偶联间期为0.429±0.089s,54例房性期前收缩伴心室内差异性传导,平均心率175±41次/min,64例6284阵心房颤动时伴有心悸、胸闷等症状,而69例27026阵发作时前无明显症状。对照组无心房颤动发生,35例有短阵房性心动过速,24例有频发房性期前收缩,56例有偶发房性期前收缩,房性期前收缩偶联间期0.633±0.014s,明显长于心房颤动组发作前与心房颤动相关的房性期前收缩及未下传的房性期前收缩偶联间期(P<0.01)。结论动态心电图监测是阵发性心房颤动诊断和疗效评价方面可靠、高效、重复性好的检查手段。

Objective To analyze significance of ambulatory electrocardiogram in diagnosing and evaluating paroxysmal atrial fibrillation(AF). Methods Number of single atrial premature beat(APB),frequency and duration of AF,coupling interval of APB in 78 cases with paroxysmal AF(AF group) and the number of single APB and coupling interval of APB in 80 cases with non AF(control group) were calculated. Results In AF group,a total of 33 314 AF occurred during 24 hours. Of them, 11 173 AF occurred at 08:00~22:00 in 36 cases and 22 141 AF at 22:00~08:00 in 74 cases. Number of APB and blast of AF during 24 hours were 8 242 ±1 245 and 456±122, respectively. Coupling interval of APB which triggered AF was 0.429±0.089 seconds. 17 cases had APB with one type of coupling interval, 33 cases with two type of coupling interval and 28 cases with more than two type of coupling interval. Average heart rate in 54 patients with APB and intraventricular aberration was 175±41 beat per minute. 6284 blast of AF occurred with symptoms of palpitation and chest discomfort in 64 cases, while 27 026 blast of AF occurred without significant symptom in 69 patients. In control group,35 cases had paroxysmal atrial tachycardia, 24 cases had frequent APB and 56 cases had occasional APB. Coupling interval of APB in control group was 0.633±0.014 seconds which was significantly greater than that in AF group (P<0.01). Conclusions Ambulatory electrocardiogram is a reliable and reproducible examination in diagnosing and evaluating paroxysmal AF.