120例房颤患者24h动态心电图分析

Twenty-four-hour ambulatory electrocardiography analysis of 120 atrial fibrillation patients

目的分析房颤患者12导联动态心电图,探讨其伴发的异常表现与年龄、疾病诊断情况及心脏器质性病变的关系,进一步认识阵发性房颤。方法收集我院动态心电图检测诊断为房颤(AF)及阵发性房颤(PAF)的120例患者的动态心电图,采用回顾性分析方法,根据动态心电图记录房颤中伴发的异常表现,结合临床资料进行分析和总结。结果 1 120例房颤患者中,动态心电图检测显示68例伴发有不同类型的心电图异常,异常发生率为68/120(56.7%),其中以快速心室率及室性早搏最多见,分别占37/120(30.8%)和35/120(29.2%),其次分别为:ST-T改变占32/120(26.7%);传导阻滞占29/120(24.2%);>2.0 s的长R-R间期占23/120(19.2%)和室性心动过速7/120(4.2%)。在65岁以上的房颤患者中,心电图伴发的异常表现在同一患者有时可达两种或两种以上。2 120例房颤患者中阵发性房颤有18例,占15%(18/120),多由房性早搏触发所致。肺心病组、冠心病组、外科检查组和风心病组都以室性早搏最多见,分别占45%(5/11)、50.0%(11/22)、42.9%(2/7)和30.0%(3/10);高血压组以ST-T改变最多见,占44.1%(15/34);胸闷、心悸组、甲亢组及糖尿病组都以快速心室率最多见,分别占38.0%(8/21)、33.3%(1/3)和22.2%(2/9);晕厥组中1例伴发快速心室率,1例伴发>2.0 s的长R-R间期。有器质性心脏病房颤患者动态心电图伴发异常表现率可高达67.4%。结论动态心电图可准确显示房颤患者伴发的心电图异常表现,在合并器质性心脏病和/或65岁以上的房颤患者中有时达两种甚至更多,可确定阵发性房颤的心电始动因素及其部位。

Objective To analyze the 12 lead ambulatory electrocardiography( AECG) of patients with atrial fibrillation( AF),and to explore the relationship between the concomitant abnormal manifestations and ages,disease diagnosis and organic heart disease,respectively,in order to know about paroxysmal atrial fibrillation( PAF) further.Methods The AECG data of 120 patients were collected who were diagnosed with AF or PAF by Holter examination.Those data were retrospectively analysed and summarized against the background of baseline,according to the concomitant abnormal manifestations during AF recorded by AECG.Results( i) There were 68 out of 120 AF cases complicating various types of ECG abnormalities by Holter examination,with an incidence rate of 56.7%( 68 /120).The most common ECG abnormalities were rapid ventricular rate and ventricular premature beats,accounting for30.8%( 37 /120) and 29.2%( 35 /120),respectively.ST-T changes,conduction block and long R-R in-tervals( > 2.0 s) successively took the next places,accounting for 26.7%( 32 /120),24.2%( 29 /120),and 19.2%( 23 /120),respectively.Among the AF patients over 65,there were sometimes two or more types of concomitant ECG abnormalities in the same case.( ii) There were 18 out of 120 AF cases diagnosed with PAF,accounting for 15%( 18 /120),mostly triggered by atrial premature beats.In pulmonary heart disease group,coronary disease group,surgery examination group and rheumatic heart disease group,ventricular premature beat was common,accounting for 45%( 5 /11),50.0%( 11 /22),42.9%( 2/7) and 30.0%( 3/10),respectively.In hypertension group,ST-T changes were more common,accounting for 44.1%( 15 /34).Rapid ventricular rate was mostly seen in chest suppression-palpitation group,hyperthyreosis group and diabetes group,accounting for 38.0%( 8 /21),33.3%( 1 /3),and 22.2%( 2 /9),respectively.In syncope group,there was one case complicating rapid ventricular rates,and one with long R-R intervals( > 2.0 s).The incidence of concomitant AECG abnormality can be as high as 67.4% among patients with organic heart disease.Conclusion Holter can accurately reveal the concomitant AECG abnormalities among AF patients,which may be two or even more types in the AF patients complicating organic heart disease and( or) the ones over 65,and determine the initiating factors and site of PAF.