老年非瓣膜性房颤合并长RR间期的动态心电图特点及环肺静脉电隔离术治疗效果

Characteristics of ambulatory electrocardiography in elderly patients with non-valvular atrial fibrillation complicating long RR interval and treatment efficacy of circumferential pulmonary vein isolation

目的分析老年非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)合并长RR间期的动态心电图特点及其临床意义,并探讨射频消融的治疗效果。方法选取在我院就诊的老年NVAF患者532例,进行24 h动态心电图监测。按有无长RR间期分为长RR间期组(399例)和非长RR间期组(133例)。分析两组的心室率、心律失常、左室功能等,并比较环肺静脉电隔离术(circumferential pulmonary vein isolation,CPVI)治疗前后心率、房颤转复等情况。结果长RR间期组睡眠期间平均、最慢及最快心室率均高于非睡眠期间,长RR间期阵次显著低于非睡眠期间(P<0.05)。长RR间期组C反应蛋白水平低于非长RR间期组,房性早搏、心律失常发生率高于非长RR间期组(P<0.05)。相较于RR间期2.0~3.0 s者,RR间期>3.0 s者的二度房室阻滞、阵发性房性心动过速、完全性或不完全性右束支阻滞发生率更低,短暂性心室停搏发生率更高(P<0.05)。行CPVI后患者平均及最快心室率降低,最慢心室率加快,长RR间期消失(P<0.05)。结论老年NVAF合并长RR间期患者容易发生心律失常、房性早搏、心室率加快。动态心电图监测可为这类患者的CPVI治疗提供参考。

Objective To analyze the characteristics and clinical significance of ambulatory electrocardiography(AECG)in the elderly patients with non-valvular atrial fibrillation(NVAF)complicating long RR interval,and to explore the treatment efficacy of radiofrequency ablation.Methods We selected 532 elderly patients with NVAF treated in our hospital and performed 24-hour AECG monitoring.According to the presence or absence of long RR interval,they were divided into long RR interval group(399 cases)and non-long RR interval group(133 cases).The ventricular rate,arrhythmia,left ventricular function,etc.were compared between the two groups,and so were heart rate,conversion of AF,etc.before and after circumferential pulmonary vein isolation(CPVI).Results In the long RR interval group,the average,the slowest and the fastest ventricular rate during sleep time are all higher than those during non-sleep time while the number of long RR intervals is significantly lower(P<0.05).The level of C-reactive protein in the long RR interval group is lower than that in the non-long RR interval group,and the incidence of atrial premature beats and arrhythmia are higher than those in the non-long RR interval group(P<0.05).In the patients with RR interval over 3.0 s,the incidence of second-degree atrioventricular block,paroxysmal atrial tachycardia,and complete or incomplete right bundle branch block are lower than those in the patients with RR interval of 2.0-3.0 s while the incidence of transient ventricular arrest is higher(P<0.05).The average and the fastest ventricular rate of the patients decrease after CPVI while the slowest ventricular rate increases,and the long RR interval disappears(P<0.05).Conclusion Elderly patients complicated by NVAF and long RR interval are prone to arrhythmia,atrial premature beats,and ventricular rate acceleration.AECG monitoring can provide references for CPVI treatment on these patients.