扩张型心肌病合并心律失常分析

Study of Dilated Cardiomyopathy Combined with Arrhythmia

目的了解扩张型心肌病(DCM)伴随心律失常的情况。方法649例DCM患者均行常规心电图、24 h动态心电图检查及心脏超声检查,对DCM患者进行心律失常分析。结果 DCM伴随心律失常的发生率分别为:伴随一度房室阻滞54例(8．3％),高度房室阻滞50例(7．7％),左束支阻滞124例(19．1％),右束支阻滞48例(7．4％),心房颤动160例(24．6％),不典型房扑28例 (4．3％),房速与窦速36例(5．5％),病态窦房结综合征7例(1％),室早与室速419例(64．5％),预激综合征4例(0．6％)。房颤与不典型房扑组(共188例)左房左右横径(LA)为(41．1±10．6)mm,同无房颤、房扑组(36．5±11．8)比较有明显差异(P<0．05),室早与室速组LVED(67．7±11．2)mm,同无室早和室速组相比(LVED65．9±13mm)无明显差异(P>0．5)。高度房室阻滞、左束支与右束支组 LVED为(70．3±14．3)mm,与无房室阻滞和束支阻滞组(LVED65．8±10．2mm)相比有明显差异,P< 0．05。结论多数DCM患者同时伴随明显心律失常,其中以室早与室速最常见;房颤、房扑组与不伴房颤和房扑组心房左右径相比有显著差异,房室阻滞、束支阻滞组与无此种心律失常的DCM组 LVED有明显差异。考虑房颤、不典型房扑及房室阻滞和束支阻滞与心脏结构明显改变有关。

Objective To investigate the occurance of arrhythmia accompany with dilated cardiomyopathy. Method Compared and analysed ultrasound cardiography and electrocardiogram of 649 patients with dilated cardiomyopathy accord with diagnostic standard of WHO. Result We found that 54 patients （8.3%） with the first degree atria-ventricular conductance block（AVB） ,50 patients（7.7% ） with high degree AVB, 124 patients （19.1% ） with left bundle branch block （LBBB） , 48 patients （7.4%） with right bundle branch block（RBBB）, 160 patients（24.6% ） with atrial fibriblation （M）, 28 patients（4.3% ） with untypical atrial flutter （AF）, 36 patients （5.5 % ） with atrial or sinus tachycardia, 7 patients （1% ） with sick sinus-atria node syndrome （SSS） ; 419 patients （64.5 % ） with preventricualr contract （ VPc ） and ventricular tachycardia （VT）, 4 patient（0.6% ） with W-P-W syndrome, The left atria（LA） diameter from left to right in the M and untypical AF group is （41.1±10.6） mm, higher than that in the group without M and untypical AF group （36.5±11.8mm） （P 〈0.05）. The left ventricular diameter of end diastolic （LVED） is （67.7±11.2） mm in the group of VPc and VT and have no obvious dirfference with the group without this kind of arrythmia （ LVED65.9±13mm） （ P 〉 0.05 ）. The LVED of the group with high degree AVB and left or right bundle brunch block is 70.3±14.3mm, higher than that of the group without block（ LVED65.8±10.2mm） （P 〈 0.05）. Conclusion DCM is combined with obvous arrhythmia especially with M, Vpc or VT, and conductance block. The atrial arrhythmia is related to atrial enlargement. The ventricular arrhythmia had no correlation to enlargement degree of left ventricle. The conductance block has relation to enlargement degree of left ventricle.