心电散点图诊断持续性心房颤动伴Ⅱ度房室传导阻滞的形态特征分析

Analysis of ECG Scatter Plot in the Diagnosis of Persistent Atrial Fibrillation with Second Degree Atrioventricular Block

目的分析动态心电图(AECG)的Lorenz散点图形态特征,探讨持续性心房颤动合并长R-R间期的性质,寻找定性诊断持续性房颤合并Ⅱ度房室传导阻滞的依据。方法回顾性分析98例24 h AECG明确诊断为持续性心房颤动病人,按散点图点区分布特征及R-R间期长短分为3组。A组17例,散点图呈“扇形”,R-R间期均<1.5 s,无相等的R-R间期,无交界性逸搏发生;B组75例,散点图呈“扇形”,R-R间期≤1.5 s或>1.5 s,无相等的R-R间期,无交界性逸搏发生;C组6例,散点图呈“扇形”合并1.5~1.9 s“曲尺伴致密棒”,R-R间期≤1.5 s或>1.5 s,有相等的R-R间期,有交界性逸搏及逸搏心律发生,分析对比3组病人AECG特征及散点图形成机制及二者关系。结果3组散点图“扇形”区对应的AECG房颤显示R-R间期绝对不等;C组散点图“曲尺伴致密棒”区对应的AECG显示有相对稳定的交界性逸搏及逸搏节律。结论持续性Af散点图呈“扇形”合并1.5 s之外“曲尺伴致密棒”的典型特征时,可直观、快速、定性诊断心房颤动合并Ⅱ度房室传导阻滞。

Objective To diagnose qualitatively the persistent atrial fibrillation(AF)accompany with second degree atrial ventricular block(AVB)by analyzing the characteristics of the RR-Lorenz plot of ambulatory electrocardiogram(AECG).Methods The clinical data of 98 patients diagnosed with persistent AF in 24 h AECG were retrospectively analyzed.All patients were divided into 3 groups according to the characteristics of the distribution of the RR-Lorenz point.There were 17 cases in group A.The scatter plots were fan-shaped,and the RR-Lorenz point lies within 1.5 seconds.There were 75 cases in group B.The scatter plots were fan-shaped.RR-Lorenz point lies without 1.5 seconds accompany with the dense area without 1.5 seconds.There were 6 cases in group C.Its scatter plot was fan-shaped with 1.5-1.9 s curve rule with compact rod.RR-Lorenz point lies without 1.5 seconds accompany with the dense area within 1.5 seconds.The characteristics of the RR-Lorenz plot among the three groups were analyzed and compared.Results The RR-Lorenz plot in all the three groups showed fan-shaped.The RR-Lorenz plot in group C was significantly different from the other groups because of the characterized change in the dense area without 1.5 seconds,which is helpful for the diagnosis of persistent AF accompany with second degree AVB.Conclusion The RR-Lorenz plot was a visual,rapid and qualitative methods in diagnosis of the persistent AF accompany with second degree AVB.