触发心房颤动的房性期前收缩特征及抗心房颤动起搏对其影响

Characterizations of atrial contractions triggering paroxysmal atrial fibrillation and the effect of atrial fibrillation prevention pacing

目的:探讨触发阵发性心房颤动(房颤)的房性期前收缩的心电图特征,并观察抗房颤起搏程序对其影响。方法:对24例植入抗心房颤动起搏器(Vitatron900E)患者进行24h动态心电图检查,分析其房性期前收缩触发阵发性房颤的情况,比较诱发房颤组与未诱发房颤组的房性期前收缩的联律间期、房性期前收缩代偿间期和房性期前收缩或房颤前2min内的房性期前收缩频率,并观察房性期前收缩后反应程序对房颤的预防作用。结果:诱发房颤组的房性期前收缩与未诱发房颤组的房性期前收缩联律间期[分别为(352.3±30.4)和(421.8±42.5)ms]、房性期前收缩代偿间期[分别为(963±109)和(733±124)ms]、房性期前收缩或房颤前2min内的房性期前收缩频率[分别为(34.8±18.9)和(12.7±8.7)次/min]比较,差异均有统计学意义(均P(0.05);7例房性期前收缩后长间歇触发的房颤用心房超速起搏,17例通过启动房性期前收缩后反应或运动后心率控制程序,6例尚需配伍用可达龙(0.2g/d)控制。结论:房性期前收缩触发阵发性房颤与房性期前收缩的联律间期、房性期前收缩代偿间期以及房性期前收缩或房颤前2min内的房性期前收缩频率有关,抗房颤起搏程序能有效防治房性期前收缩等触发的阵发性房颤。

Objective To evaluate the electrocardiographic characterizations of atrial contractions （ AC ） triggering paroxysmal atrial fibrillation （AF） , and to explore the effects of AF prevention pacing on their electrocardiographic characterizations. Methods plantation of AF therapy pacemaker（ Vitatron 900E ） were analyzed by AC triggering paroxysmal AF with Hoher monitoring in the study. AC compluing interval, compensatory pause and frequency 2 minutes before the AF or during the AC were compared between the induced paroxysmal AF group and noinduced paroxysmal AF group, and the preventive effect of AF on the post-PAC response program was investigated. Results There was significant difference in the AC compluing interval [ （352.3 ± 30.4） vs （421.8±42.5）ms], compensatory pause [（963 ± 109） vs （733 ± 124） ms], and frequency [ （ 34.8 ± 18.9 ） vs （ 12.7 ± 8.7 ）/min ] 2 minutes before the AF or during the AC in the induced paroxysmal AF group, compared with those in the noinduced paroxysmal AF group （all P 〈0.05 ）. The AF of 7 patients were controlled by atrial overdrive pacing therapy, 17 patients by post-AC-response or/and post-exercise control therapy, 6 patients by the above therapy combining with cordarone （0.2 g/d ）. Conclusion AC triggering paroxysmal AF is related to the compluing interval, compensatory pause and frequency 2 minutes before the paroxysmal AF or during the AC, AF prevention pacing may be helpful for the paroxysmal AF induced by AC.