心电图对心房颤动病因的诊断价值

Evaluation of Electrocardiographic Study on Pathogeny of Atrial Fibrillation

目的探讨常规心电图分析在心房颤动（ａｔｒｉａｌｆｉｂｒｉｌａｔｉｏｎ，Ａｆ）病因诊断中的意义。方法对１００例Ａｆ心电图ｆ波及伴随的其它ＥＫＧ改变进行分析；临床上通过体检、实检等明确Ａｆ病因，进行上述二者间的相关性研究；并观察心电图诊断Ａｆ病因的敏感性与特异性。结果１００例Ａｆ患者心电图中ｆ波＜１ｍｍ４８例，１～２ｍｍ４５例，＞２ｍｍ７例。冠心病引起的ｆ波多＜２ｍｍ，风心ｆ波＞２ｍｍ亦不多见，但ｆ波＞２ｍｍ主要为风心所致。以ｆ波＞２ｍｍ诊断风心病（６／２０）敏感性差，仅为３０％，特异性却达８５．７％（６／７）。但伴随右室肥厚及心电轴右偏明显者提示病因为风心和（或）肺心。左室肥厚、左束枝传导阻滞（ＬＢＢＢ）、右束枝传导阻滞（ＲＢＢＢ）、Ａ－Ｖ传导阻滞对高心、冠心诊断有高度提示意义。结论心电图对Ａｆ病因诊断具有重要参考价值。以ｆ波＞２ｍｍ者可提示诊断为风心，若与其它伴随的ＥＫＧ改变往往对病因诊断更具有诊断意义。

Objective To study the significance of general electrocardiogram (EKG) in the pathogenic diagnosis of atrial fibrillation (Af).Methods 100 Af cases took part in this study,whose pathogeny of Af was first diagnosed by routine physical and experimental examinations. Every case was also taken EKG wtih emphasis on analysing f wave of EKG and other changes and then the relation was carefully studied between EKG and pathogeny.Results There were 48 cases whose f wave<1 mm,45 cases whose f wave 1～2 mm, 7 cases whose f wave> 2mm.There was only 1 case whose f wave> 2mm in coronary heart disease group., 33% (6/20) cases whose f wave> 2 mm were in rheumatic valvular disease group.Most cases whose f wave> 2mm were caused by rheumatic valvular disease. The sensitivity and specificity of using f wave> 2mm to diagnose rheumatic valvular disease were 30% and 85.7%, respectively. F wave> 2mm accompanied by right ventricular hypertrophy and electrical axis of heart obviously leaning right highly suggested rheumatic valvular disease and/or cor pulmonale. Left ventricular hypertrophy, left bundle branch block (LBBB), right bundle block (RBBB) and auriculoventricular block (AVB) were highly recommended to diagnose hypertensive heart disease and coronary heart disease.Conclusion Analysing general EKG had an important referential value for studying Af etiology.F wave>2 mm was highly suggested to diagnose rheumatic heart disease but f wave>2 mm accompanied by other EKG changes were more important for Af pathogenic diagnosis.