中老年房间隔缺损患者介入封堵术前后心电图对比分析

Comparison of electrocardiogram characteristics in patients over 40 years of age before and after transcatheter closure of atrial septal defect

目的探讨中老年房间隔缺损(atrial septal defect,ASD)患者(年龄≥40岁)介入封堵术前后心电图(ECG)的改变。方法经导管介入治疗成功的305例ASD患者,每例封堵术前及术后24 h均常规行12导联ECG各1次,其中19例术前有各种心律失常行24 h动态心电图检查。观察分析介入封堵前后ECG变化。结果封堵术后QRS电轴由术前(79.1±36.1)°转变为(76.4±36.8)°,差异有统计学意义(P<0.05);与术前比较,术后正常心电图比例增加,右束支传导阻滞发生率明显减少(P<0.01);术后右心房肥大、右心室肥厚例数虽然减少,但差异无统计学意义(P>0.05);术后窦性心动过缓例数显著增加(P<0.01),但年龄、缺损直径和封堵器大小与心率≥60次/min的非窦性心动过缓者相比较差异无统计学意义(P>0.05);7例患者术后出现心房颤动,术后发生心房颤动患者的年龄、缺损直径和封堵器大小与非心房颤动者比较差异有统计学意义(P<0.01)。其他心律失常封堵前后无明显变化(P>0.05)。结论中老年ASD患者封堵治疗后短期内即可使与右心容量负荷有关的部分心电图指标有所改善,封堵治疗术后可出现新的心律失常,对于已经形成的持续心律失常短期内不会改善。

Objective To evaluate the electrocardiographic （ECG） characteristics before and after transcatheter closure of atrial septal defect （ASD） in patients over 40 years of age. Methods Each of 305 ASD patients underwent 12-lead ECG once at 24 h before and after closure procedure. Nineteen patients with cardiac arrhythmia confirmed preoperatively underwent 24-hour ambulatory ECG monitoring. ECG features were observed and analyzed. Results The QRS axis declined from （79. 1±36. 1 ） degrees to （76.4 ± 36.8） degrees （P 〈 0.05）. The incidence of normal ECG increased and right bundle branch block significantly decreased after transeatheter closure （P 〈 0.01 ）. The number of the right heart dilatation decreased but no difference was found （P 〉0. 05）. The incidence of sinus bradycardia increased significantly （P 〈 0.01 ） and was related to age, diameter of defect, and size of closure （P 〉 0.05）. Seven patients developed atrial fibrillation. Significant difference was found in age, diameter of defect, and size of closure between patients with atrial fibrillation and those without atrial fibrillation （P 〈 0.01 ）. There was no significant change in other patients with arrhythmia （P 〉0.05）. Conclusion Volume load of the right ventricle is decreased after transeatheter closure of atrial septal defect in patients over middle age. New arrhythmia can form while some persistent arrhythmia may remain unchanged within short period of time after transeatheter closure.