无症状阵发性心房颤动的临床特点分析

The clinical features of asymptomatic paroxysmal atrial fibrillation

目的探讨无症状阵发性心房颤动的发作规律及临床特点,寻找筛查无症状阵发性心房颤动的方法。方法收集确诊为阵发性心房颤动的患者134例,根据动态心电图及临床资料,分为无症状组55例和症状组79例。分析2组24h平均心室率、P波离散度、临床特征等的差异,并进行多元logistic回归分析。结果 2组P波离散度比较差异无统计学意义(P>0.05)。无症状组男性比例明显多于女性(P<0.01),24 h平均心室率及心房颤动发作时的平均心室率明显低于症状组(P<0.01)。无症状组服用β受体阻滞剂的比例及夜间发作心房颤动次数明显高于症状组[65.5%vs 40.5%,(20.18±4.85)次vs(3.27±1.74)次,P<0.05,P<0.01]。多元logistic回归分析,男性、夜间阵发性心房颤动、服用β受体阻滞剂、24h平均心室率、阵发性心房颤动时最快心室率和平均窦性心率患者更易发生无症状阵发性心房颤动(P<0.05)。结论男性、夜间心房颤动、服用β受体阻滞剂及平均心室率较慢的患者发作心房颤动时,表现为无症状,动态心电图可以作为高危人群的筛查手段。

Objective To investigate the episodes and clinical features of asymptomatic paroxysmal atrial fibriilation（PAF） and search a practical screening method of asymptomatic PAF. Methods Consecutive patients who were diagnosed as PAF by 12-lead dynamic electrocardiography（DCG） were enrolled between October 2009 and March 2010 in this hospital. The episode features of PAF in DCG and clinical data were analyzed at the same time. The patients were divided into two groups according to presence or absence of symptoms. Their P wave dispersion,average ventricular rate and clinical features were compared. Results Seventy nine patients were symptomatic and 55 patients were asymptomatic in the total of 134 patients. There was no significant statistical difference in P wave dispersion between the two groups. The incidence of asymptomatic PAF was higher in males （P 〈 0.05） than in females. Average ventricular rate either in sinus rhythm or in atrial fibrillation rhythm was significantly higher in symptomatic group than in asymptomatic group. The rate of taking beta-blocker and rate of PAF at night were higher in asympotomatic group than in symptomatic group （P 〈 0.05）. Conclusions Male,PAF at night,taking beta blocker and low average ventricular rate are features of the patients presenting asymptomatic PAF. DCG can be a practical screening method for high risk patients of PAF.