阵发性心房颤动发作的启始节律特征观察

Observation of characteristics of initial rhythm before the occurrence of paroxysmal atrial fibrillation

目的观察阵发性心房颤动(简称房颤)发作的启始节律特征。方法由动态心电图(Cardio Trak动态分析软件,杭州百慧医疗设备有限公司)记录,并由时间RR间期(t-RR)散点图及相应心电图确诊为阵发性房颤的14例患者,再通过t-RR散点图及逆向技术追溯出相应房颤启始节律的诊断心电图,采用手工测定的方法,测定房颤启始前的5个波形,4个心动周期,计算早搏指数[房性早搏(简称房早)联律间期÷其前面的一房性心动周期长度],分析房颤的启始节律特征。在5个波形中,S表示窦性心房波,P示房早波,P'示第2个房早波,P1为异位心房波。结果 14例共发生45次阵发性房颤;其中①以S→S→S→S→P方式(窦性房波基础上)26次,占57.8%;②以P→S→P→S→P或S→S→P→S→P方式(房早二联律)10次,占22.2%;③以P→S→S→S→P或S→P→S→S→P或P→P→S→S→P方式(不纯性窦性房波基础上)7次,占15.6%;④以P1→P1→P1→P1→P方式(房性心动过速)2次,占4.4%。在①中,I<0.5(n=19)者有短长短周期现象,I>0.5(n=7)者有房波频率增快趋势,是另外因素(联律间期较短,P'波、房性并行心律)辅助诱发了房颤。在②中系房早二联律造成了短长短现象,使I<0.5,房早诱发了房颤。在③中存在房波频率快→慢→快的变化,即使I>0.5,亦能发生房颤。在④中房早终止房性心动过速时发生了房颤。结论不同启始节律的房早诱发房颤的房波发生的性质不同,其基础房波的变化慢快也不一致,此决定了其房颤节律启始控制的方法也应不一致。

Objective To investigate the characteristics of initial rhythm before the occurrence of paroxysmal atrial fi- brillation （AF）. Methods Fourteen AF patients who were diagnosed by Hoher ECG recording, time-RR scatter dia- gram and corresponding ECG, were enrolled. The diagnostic ECG of the initial rhythm of AF was retrieved by time-RR scatter diagram and reverse technique. Five waves and four activation cycle length were measured manually, and the index of premature beat （ defined as coupling interval of atrial premature beat divided by the preceding atrial activation cycle length）. The initial rhythm after the occurrence of AF was analyzed. Results Forty five episodes of AF were observed in 14 patients, in which （1） 26 episode （57.8%） showed S→S→S→S→P （on the basis of sinus P wave） ; （2） 10 episode （22.2%） with P→S→P→S→P or S→S→P→S→P （ atrial bigeminy） ; （3） 7 episode（ 15.6% ） with P→S→S→S→P or S→P→S→S→P or P--~P→S→S→＋P （ impure sinus P wave） ; @ 2 episode （ 4.4% ） with P1→P1 →Pl →P1 →P （ atrial tachycardial）. In first pattern, I〈0.5 （n= 19）showed short-long-short rhythm while I〉0.5 （n=7）showed an increase trend in atrial activation, and other factor such as short coupling interval, P＇wave or atrial parasystolic rhythm induced AF. In the second pattern, atrial bigeminy caused short-long-short rhythm, 1〈0.5, and atrial premature beat induce AF. In the third pattern, the change of rapid-slow-rapid was observed in the atrial activation frequency. AF was induce even with I〉0.5. In the fourth pattern, AF was initiated just after the termination of atrial tachycardial by atrial premature beat. ConclusionThe characteristics of atrial waves of the premature beat which indues AF is different, and the change of basic atri- al waves is also different. This phenomenon determines the difference in the control manner of initial rhythm of AF.