继发孔型房间隔缺损患者心律失常的临床研究

Clinical study on arrhythmias in patients with secundum atrial septal defect

目的心律失常是继发孔型房间隔缺损(ASD)的常见并发症,本研究探讨未行介入封堵术和外科修复术治疗的ASD患者心律失常的发生情况及其可能危险因素,以期为指导心律失常的防治工作提供理论依据。方法所有患者行18导联常规心电图、24小时动态心电图(Holter)、床旁心电监护检查,记录心律失常类型。经胸超声心动图(TTE)测ASD最大径、右室与左室内径比值(RV/LV)、三尖瓣反流法估测肺动脉收缩压(PASP)等临床资料进行统计分析。结果共收集77例患者,年龄57.19±15.59岁,女性51人(66.2%)。29例(37.6%)患者ASD最大径>20 mm;47例(48.1%)患者肺动脉收缩压>50 mmHg;29例(37.6%)患者右室明显增大,右室内径/左室内径比例≥1.0。心律失常类型共计19种,患者发病年龄大多分布在60岁以上(48.1%)。其中多源室性期前收缩(室早)(r=6.506,P=0.039)、心房颤动(r=9.109,P=0.011)、成对房性期前收缩(房早)(r=6.241,P=0.044)及非持续性房性心动过速(房速)(r=9.653,P=0.008)随年龄增大发病率有增加的趋势。随着年龄增大,心律失常发生种类有增多的趋势(z=-3.168,P=0.002);随着ASD最大径的增大,室性心律失常发病率有增加的趋势(χ^(2)=3.983,P=0.046)。结论继发孔型房间隔缺损未行手术修补或介入封堵治疗的患者,当ASD最大径>20 mm,肺动脉收缩压>50 mmHg,RV/LV≥1.0,年龄大于60岁时心律失常的发生率明显增加,病情加重,临床应当引起重视。

Objective To investigate the occurrence of arrhythmias and the underlying possible risk factors in the patients with secundum atrial septal defect(ASD)who have not undergone interventional closure or surgical repair.Methods From February 2016 to February 2020,77 patients with simple secundum ASD over 18 years old who were hospitalized in Shanxi cardiovascular disease hospital and received conservative treatment without interventional occlusion and surgical repair were selected as the research objects.18-lead conventional electrocardiogram,24-hour ambulatory electrocardiogram(Holter)and bedside ECG monitoring were used to record the type of arrhythmias.Transthoracic echocardiography(TTE)was uesd to measure the maximum diameter of ASD and the ratio of right ventricle to left ventricle.The tricuspid valve regurgitation method was used to estimate the pulmonary artery systolic pressure(PASP).And other clinical data were for statistical analysis.Results There were 19 types of arrhythmias in patients,multi-source ventricular premature(r=6.506,P=0.039),atrial fibrillation(r=9.109,P=0.011),paired atrial premature(r=6.241,P=0.044),unsustainable atrial tachycardia(r=9.653,P=0.008)had a increase tendency,with the increasing of age,the types of arrhythmia tended to increase too(z=3.168,P=0.002),the incidence rate of ventricular arrhythmia was proportional to the maximum diameter of ASD(χ^(2)=3.983,P=0.046).Conclusion For patients with secundum atrial septal defect without surgical repair or interventional closure procedures,once the maximum diameter of ASD more than 20 mm,pulmonary artery systolic pressure more than 50 mm Hg.RV/LV equal or more than 1.0 and the age is older than 60 years old,the incidence of arrhythmias would increase significantly.