心房颤动患者短联律间期室性期前收缩易发部位研究

Common Sites of Short-term Interventricular Premature Beats in Patients with Atrial Fibrillation

目的探讨心房颤动患者短联律间期室性期前收缩的发生与心室解剖位置。方法回顾性分析2016年厦门大学附属第一医院就诊的323例心心房颤动动伴室性期前收缩患者的24 h动态心电图。通过Lorenz散点图测量心房颤动患者室性期前收缩点集中最短联律间期,并采用逆向技术确定该室性期前收缩的起源部位。结果室性期前收缩起源左、右心室心尖部的联律间期最短,测量值分别为(380±55)、(394±58)ms,二者比较,差异无统计学意义(P>0.05);左心室心尖部短联律间期测量值低于左心室流入道、左心室流出道、右心室流入道、右心室流出道(t=4.89,P<0.01;t=5.61,P<0.01;t=3.90,P<0.01;t=5.99,P<0.01);右心室心尖部短联律间期测量值低于左心室流入道、左心室流出道、右心室流入道、右心室流出道(t=2.18,P=0.03;t=3.09,P<0.01;t=2.07,P=0.04;t=3.11,P<0.01)。结论心房颤动患者心尖部较易发生短联律间期的室性期前收缩,其可能与病理生理及心尖部的结构和功能有关。

Objective To determine the occurrence of short-term interventricular premature beats and ventricular anatomical position in patients with atrial fibrillation（AF）.Methods A retrospective analysis of the 24 h dynamic electrocardiograms of 323 patients with AF and ventricular premature beats treated at the First Affiliated Hospital of Xiamen University in 2016 was performed.The Lorenz scatter plot was used to measure the point of the shortest conjugation among the ventricular premature beats in patients with AF,and the origin of the premature ventricular contractions was determined using the reverse technique.Results The measurements of short-term intervals of ventricular premature beats which originated from the left ventricular apex and right ventricular apex were the shortest[（380 ± 55） ms and（394 ± 58） ms],respectively.There was no significant difference between the two groups（P〉0.05）.The measurements of short-term intervals of ventricular premature beats was lower in the left ventricular apex than left ventricular inflow tract,left ventricular outflow tract,right ventricular inflow tract,and right ventricular outflow tract（t=4.89,P〈0.01;t=5.61,P〈0.01;t=3.90,P〈0.01;t=5.99,P〈0.01,respectively）.The measurements of short-term intervals of ventricular premature beats was lower in the right ventricle apex than left ventricular inflow tract,left ventricular outflow tract,right ventricular inflow tract,and right ventricular outflow tract（t=2.18,P=0.03;t=3.09,P〈0.01;t=2.07,P=0.04;t=3.11,P〈0.01,respectively）.Conclusion The apical level in patients with AF is prone to short-term interventricular premature beats,which may be related to pathophysiology,apical structure and function.