永久性心房颤动合并长RR间期的临床意义

Clinical significance of permanent atrial fibrillation with Long RR interval

目的观察永久性心房颤动(AF)合并长RR间期的患者,通过射频消融恢复窦性心律后的心电图变化情况,探讨AF合并长RR间期的临床意义。方法射频消融术前行动态心电图检查,术后观察窦性心律心电图的PR间期,分析术前动态心电图各项参数与术后PR间期的关系。结果424例AF行射频消融的患者中,合并长RR间期者43例,其消融前动态心电图平均心率(80.5±13.1)次/分、最快心率(133.2±27.7)次/分、最慢心率(52.7±9.7)次/分,≥1.5秒的长RR间期的中位数435次/24h。消融术后平均PR间期(0.18±0.04)秒,9例PR间期延长(0.24±0.03)秒,无二度房室传导阻滞。结论合并≥1.5秒的长RR间期是心房颤动患者的常见临床现象,其产生机制主要是房室结的隐匿性传导和生理性干扰,而并非病理性的房室传导阻滞。

Objective To invest＇igate the clinical significance of permanent atrial fibrillation with long RR interval more than 1.5 seconds by means of observation of atrioventricular conduction characteristic after radiofrequency ablation of permanent atrial fibrillation with long RR interval. Methods Statistical analyse of various parameters on ambulatory electrocardiogram before ablation. Observation of the longest PR interval on 12 lead surface electrocardiogram and comparison of ages and duration of atrial fibrillation. Results Permanent atrial fibrillation with long RR interval more than 1.5 seconds was observed in 43 patients. The mean, maximal and minimal ventrieular rates were （80.5 ± 13.1 ） bpm, （ 133.2 ± 27.7） bpm, and （52.7 ± 9.7 ） bpm respectively. The median number of LRR 1.5 during 24 hours was 435/24 h. The sinus rhythm were restored and maintained in the patients after radiofrequeney ablation. The mean PR interval on 12 lead surface ECG was （0.18 ±0.04）s. 9 patients had abnormal PR interval with mean PR interval of （ 0.24 ± 0.03 ） s. No two degree atrioventricular block was observed. Conclusion Long RR interval more than 1.5 seconds is a frequent clinical phenomenon in patients with atrial fibrillation. The mechanism for long RR interval might be concealed conduction and physiological interference in atrioventrieular node, rather than pathologic atrioventrieular block.