12导联动态心电图检测分析阵发性房颤触发因素

Monitoring and Analysis of Paroxysmal Atrial Fibrillation and Its Related Triggering Factors by 12-leads HOLTER

目的应用12导联动态心电图检查观察阵发性房颤发作及其相关的房性心律失常的特征,探讨其发生的触发因素.方法对47例阵发性房颤患者行12-HOLTER检测,其中男性20例,女性27例,平均(64.89±12.70)岁.对阵发性房颤组(分为诱发组、未诱发组)及对照组心电图特征进行分析,探讨触发机制.结果 (1)41例患者的12-HOLTER检出阵发性房颤79阵/次.72阵/次由房性早搏诱发,占91.1%(72/79);6阵/次突然发生,占7.6%(6/79);1阵/次由心房扑动所诱发,占1.3%(1/79);(2)诱发组与未诱发组及对照组相比,房性早搏联律间期明显缩短,(490±90)ms,(590±140)ms,(630±90)ms,P<0.05;房早指数明显较小(0.52±0.12),(0.62±0.09),(0.71±0.06),P<0.05;房性早搏呈"P'on T"现象几率明显增高(84.72%,26.39%,2.78%,P<0.05);诱发组的房早前周期较对照组明显延长(990±280)ms,(940±210ms),P<0.05;(3)阵发性房颤发作前2 min^30 s内与总时程内的房性早搏频度相比明显增大(由0.43次/min增加至3.5次/min、6.00次/min,P<0.05);(4)诱发阵发性房颤的房性早搏多起源于左心房上部(61/72,84.7%).结论阵发性房颤多由房性早搏所诱发,其中房性早搏联律间期短、房早指数小、呈"P'on T"现象、房早前周期延长同时房性早搏频度增快时更容易诱发阵发性房颤的发生,且大部分起源于左心房上部.

Objective To apply 12-leads HOLTER monitoring and analysis to observe paroxysmal atrial fibrillation （PAF） and its related atrial arrhythmias so as to explore the triggering factors of PAF. Methods 47 patients with PAF, including 20 male patients and 27 female patients, were given 12-HOLTER monitoring and analysis. Their average age was 64.89 ±12.70 years-old. PAF patients were subdivided into 2 subgroups： the triggered PAF subgroup and the untriggered PAF subgroup. Patients with atrial premature beats but without PAF were selected into the control group. The PAF and its related atrial arrhythmias were detected and analyzed by 12-HOLTER. Results （1） 9 events of PAF were found in 47 patients by 12-HOLTER monitoring and analysis, among them 72 events of PAF were triggered by atrial premature （AP） （91.1%, 72/79） , 6 events of PAF occurred automatically and suddenly （7.6%, 6/79） ; and only 1 events of PAF was triggered by atrial flutter （1.3%, 1/79） . （2） The coupling interval of AP in the triggered PAF subgroup was significantly shorter than that of the untriggered PAF subgroup and control group （490 ±90ms vs. 590 ±140 ms and 630 ±90ms, P〈0.05） ; The index of AP was smaller significantly in the PAF group than that of the untriggered PAF subgroup and controll group （0.52 ±0.12 vs. 0.62 ±0.09 and 0.71 ±0.06, P〈0.05） ; The ＂P＇ on T＂ of AP was significantly higher in the PAF group than that of the untriggered PAF subgroup and control group （84.72% vs. 26.73% and 2.78%, P〈 0.017） ; The interval before the AP in PAF group was prolonged more significantly than that of controlled group （990 ±280 ms vs. 940 ±210 ms, P〈0.05） （3） During 2 min - 30 s before the PAF occurrence control as total times, the AP appeared more frequently （from 0.43 beats/rain to 3.5 - 6.00 beats/min, P〈0.017） . （4） Most of the AP which triggered PAF was originated from the upper part of the left atrium （61/72, 84.7%） Conclusions Most events of PAF are triggered by AP, the AP which can trigger PAF may be of some of the features such as a shorter coupling interval, a smaller AP index, ＂P＇ on T＂ and a longer interval before the AP, PAF more occurrence while the AP may take place more frequently. Most of the AP which triggered PAF are originated from the upper part of left atrium.