风湿性心脏病房波传导的研究

Study on Atrial Wave Conduction in Patients with Rheumatic Heart Disease

目的 采用心外膜标测方法,对风湿性心脏病慢性房颤患者及窦性心律患者心房房波的传导顺序进行比较研究。方法 选择风心病慢性房颤患者23例及风心病窦性心律患者12例,采用48导同步心外膜标测,通过心外膜电图对房颤的同形态房波及窦性房波的传导顺序进行分析,并对房波传导时间及波宽进行比较。结果 窦性心律组右房侧壁上部房波最为领先,平均右房房波早于左房房波(72.2±19.8)ms,慢性房颤组患者同形态房波则以左房后下部房波最为领先,平均左房房波早于右房房波(80.2±25.7)ms;窦性心律组房波心房传导时间为(149.5±28.4)ms,慢性房颤组同形态房波心房传导时间为(151.5±35.4)ms,两者心房传导时间比较无明显差异,P>0.05;窦性心律组房波波宽为(41.3±12.7)ms,慢性房颤组房波波宽(39.0±10.5)ms,两者波宽比较无明显差异,P>0.05。结论 风心病窦性心律患者心房房波由左房传向右房,而慢性房颤患者的房波由右房传向左房,窦性房波与慢性房颤同形态房波的心房传导时间及波宽无显著差别。

Objective To study the sequence of atrial wave conduction in rheumatic heart disease patients with atrial fibrilktion or with sinus rhythm by intra - operative epicardial mapping. Methods Twenty - three patients with chronic atrial fibrillation and twelve patients with sinus rhythm in rheumatic heart disease underwent 48-lead epicardial mapping during operation, the sequence of atrial waves and their conduction time and wave width were analyzed. Results The earliest part of atrial waves located in upper-lateral wall of right atrium in sinus rhythm group and atrial waves of right atrium were (72.2 ± 19.8) ms earlier than that of left atrium , whereas in atrial fibrillation group the earliest part of atrial waves located in lower-posterior wall of left atrium and atrial waves of left atrium were (80.2 ± 25.7) ms earlier than that of right atrium. Atrial wave conduction times in both groups were (149.5 ± 28.4)ms and (151.5 ±35.4)ms and wave widths were (41.3 ±12.7)ms and (39.0 ±10.5)ms respectively. Atrial wave conduction times and wave widths showed no significant difference in both group, both P >0.05. Conclusion Atrium waves in sinus rhythm group conduct from right atrium to left atrium and opposite in atrial fibrilktion group. There were no significant difference in conduction time and wave width of atrial waves between the two groups.