常规心电图与动态心电图对起搏器植入术后患者心律失常的诊断比较

Comparison of conventional electrocardiogram and dynamic electrocardiogram in diagnosis of arrhythmia in patients after pacemaker implantation

目的比较常规心电图与动态心电图对起搏器植入术后患者心律失常的诊断价值。方法选择2015年9月～2017年12月在我院接受起搏器植入的患者78例,按起搏部位分为右心室间隔(RVS)起搏组40例和右心室心尖(RVA)起搏组38例,两组在术中与术后均行常规心电图与动态心电图检查与诊断,观察起搏参数的变化与术后心律失常的发生情况。结果所有患者起搏电极成功固定于RVA或RVS部位,两组的R波幅度、阻抗、电流、起搏阈值等比较差异无统计学意义(P>0.05)。术后RVA组的S-D时限为(0.034±0.001)s,S-R时限为(0.098±0.013)s,QRSd为(0.142±0.012)s;而RVS组分别为(0.033±0.002)s、(0.077±0.005)s、(0.116±0.009)s,RVS组的S-R时限与QRSd值显著少于RVA组(P<0.05)。动态心电图对窦性停搏、室性早搏等心律失常检出率要显著高于常规心电图(P<0.05)。以动态心电图作为金标准,RVS组术后心律失常与RVA组比较差异无统计学意义(P>0.05)。结论动态心电图能及时观察到起搏器植入术后患者心律失常的发生,也能反映RVS与RVA部位起搏术中与术后的各项功能状况,为临床治疗与预后提供参考。

Objective To compare the diagnostic value of conventional electrocardiogram and dynamic electrocardiogram in patients with arrhythmia after pacemaker implantation. Methods 78 patients who underwent pacemaker implantation in our hospital from September 2015 to December 2017 were enrolled. According to the pacing site, the patients were divided into right ventricular septal （RVS） pacing group （40 cases） and right ventricular apex （RVA） pacing group （38 cases）. The patients in two groups underwent routine electrocardiogram and dynamic electrocardiography examine and diagnosis during and after operation. The changes of pacing parameters and the occurrence of postoperative arrhythmia were observed. Results All patients＇ pacing electrodes were successfully fixed in RVA or RVS. There was no significant difference in R wave amplitude, impedance, current and pacing threshold between the two groups（P〉0.05）. The SD time limit of the postoperative RVA group was（0.034±0.001） s, the SR time limit was（0.098±0.013） s, the QRSd was （0.142±0.012） s, while those of the RVS group were （0.033±0.002） s, （0.077±0.005）s, （0.116±0.009） s, respectively.The SR time limit and QRSd values of the RVS group were significantly less than those of the RVA group（P〈0.05）. The detection rate of arrhythmia such as sinus arrest and ventricular premature beats by dynamic electrocardiogram was significantly higher than that by conventional electrocardiogram（P〈0.05）. With dynamic electrocardiogram as the gold standard, there was no significant difference in postoperative arrhythmia between RVS group and RVA group（P〉0.05）. Conclusion Dynamic electrocardiogram can timely observe the occurrence of arrhythmia in patients after pacemaker implantation, and can also reflect the functional status of RVS and RVA during and after pacing, providing a reference for clinical treatment and prognosis.