心房颤动患者伴≥2 s长R-R间期的发生机制研究

Occurrence Mechanism of Long R-R Interval≥2 s in Atrial Fibrillation Patients

目的:探讨心房颤动患者伴≥2 s长R-R间期的发生机制。方法:回顾性分析2019年1-12月在厦门大学附属第一医院就诊的369例房颤患者的24 h动态心电图,根据Holter中是否伴有长R-R间期(≥2.0 s)分为病例组(181例)及对照组(188例),并根据长R-R间期出现时间是否与睡眠相关将病例组分为睡眠相关组(122例)和睡眠无关组(59例)。分别比较病例组与对照组及睡眠相关组与睡眠无关组的24 h心率变异性(HRV)指标24 h R-R间期总体标准差(SDNN)、24 h心率减速力(DC)、最短房室结功能不应期(AVNFRP)、AVNFRP变化值及最长R-R间期发生时基础周期条件下的AVNFRP,并对睡眠相关组和睡眠无关组的24 h SDNN 及24 h DC进行白天(06:00-22:00)夜间(22:00-06:00)比较分析。结果:病例组24 h R-R间期总体标准差(SDNN)、24 h DC及AVNFRP变化值均明显高于对照组(P<0.05),最短AVNFRP及最长R-R间期发生时基础周期条件下的AVNFRP均较对照组显著长(P<0.05);睡眠无关组的24 h SDNN、24 h DC及AVNFRP变化值均明显高于睡眠相关组,最短AVNFRP及最长R-R间期发生时基础周期条件下的AVNFRP均较睡眠相关组显著延长(P<0.05);睡眠无关组白天与夜间的SDNN、DC比较差异均无统计学意义(P>0.05),而与睡眠相关组比较,其白天SDNN、DC及夜间SDNN均显著高(P<0.05),夜间DC比较差异均无统计学意义(P>0.05),睡眠相关组白天SDNN、DC均明显低于夜间(P<0.05)。结论:SDNN、DC增高是房颤伴睡眠相关性长R-R间期发生的重要原因,而房室结功能不应期的病理性延长则是房颤伴睡眠无关性长R-R间期发生的重要原因。

Objective:To explore the occurrence mechanism of long R-R interval (≥2 s) in atrial fibrillation patients.Method:A retrospectively analysis of 24 hour dynamic electrocardiogram in 369 AF patients who were visited to First Affiliated Hospital of Xiamen University from January to December 2019 was conducted.All participants were divided into the case group (n=181) and the control group (n=188) according to the presence of long R-R interval (≥2.0 s).The patients were divided into sleep-related group (n=122) and sleep-unrelated group (n=59) according to whether the occurrence time of long R-R interval was related to sleep.The 24 hour standard deviation of R-R interval (SDNN) which was index of the heart rate variability (HRV),deceleration capacity of heart rate (DC),shortest atrioventricular node refractory period (AVNFRP),the variation value of AVNFRP and the AVNFRP at the same basic cycle length to the longest R-R interval were respectively analyzed and compared between the case group and the control groups,and the sleep-related and sleep-unrelated groups.The 24 h SDNN and 24 h DC were compared in daytime (06:00-22:00) and nighttime (22:00-06:00) between the sleep-related and sleep-unrelated groups.Result:The 24 hour standard deviation of R-R interval (SDNN),24 hour DC and the variation value of AVNFRP in the case group were significantly higher compared with the control group (P<0.05).The shortest AVNFRP and the AVNFRP at the same basic cycle length to the front R-R interval of the longest R-R interval in the case group were both dramatically longer than those in the control group (P<0.05).The 24 hour SDNN,24 hour DC and the variation value of AVNFRP in the sleep-unrelated group were also all remarkably higher compared with the sleep-related group,the shortest AVNFRP and the AVNFRP at the same basic cycle length to the longest R-R interval in the sleep-unrelated group were also both significantly longer than the sleep-related group (P<0.05).There were no difference between the diurnal and nocturnal SDNN,DC in the sleep-unrelated group (P>0.05),while the diurnal SDNN,DC and the nocturnal SDNN in the sleep-unrelated group were obviously higher than the sleep-related group (P<0.05),and no imparity between the nocturnal DC of the two groups (P>0.05).The diurnal SDNN,DC were both prominently lower than the nocturnal ones in the sleep-related group (P<0.05).Conclusion:The main mechanism for sleep-related long R-R interval might be higher SDNN and DC,but the important mechanism for sleep-unrelated long R-R interval might be the prolongation of AVNFRP.