阵发性心房颤动发作之前的基础房律特性分析

Analysis of basic atrial rhythm characteristics before episodes of paroxysmal atrial fibrillation

目的探讨阵发性心房颤动(简称房颤)发作之前的基础房律特性,了解其房律特性是否与房颤发生相关。方法对动态心电图数据库中的8 000份原始电子资料(均由杭州百慧医疗设备有限公司生产的动态心电图记录仪记录),采用相应的软件,在浏览栏中,使用结论'阵发性心房颤动'搜索,寻获相应病例数据,编号,集中备份,再对备份数据采用散点图及逆向技术精细分析。观察到阵发性房颤起始节律后,在此时刻点截取12导联心电图,存储在指定硬盘中,以便后续采用Windows照片查看器将图片放大至适当程度测量房颤发作前Ⅱ、aVR、V1导联上的P波时限和振幅。统计房颤发生前后各1 h的窦性心律和房颤时的平均心率,以及1 h窦性心律中发生的房性早搏(简称房早)、成对房早、二联律房早以及房性心动过速(简称房速)的个或次数。当阵发性房颤病例(阵发性房颤组)确定后,根据其组病例顺号,按性别匹配在同样的数据库中寻找窦性心律合并房早的病例(对照组),再根据房颤发作前1 h的时刻,在对照组中病例的相应时刻,统计1 h的窦性心率以及房性异位心搏的相应指标,截取一段12导联心电图,作相应存盘,后续采用前述同样方法测量Ⅱ、aVR、V1导联上P波时限和振幅。结果共获取阵发性房颤79例,最终阵发性房颤组55例(有1例基础节律为心房扑动,故除外),对照组56例。两组年龄比较,无显著差异[(68.7±9.8)岁vs(66.2±15.1)岁,P>0.05]。房颤发作后1 h平均心率明显增快[(99±21)次/分vs(70±12)次/分,P<0.001]。与对照组比较,阵发性房颤组窦性心律时,单个房早的发生无明显差异(中位数:31.0 vs 43.5,P>0.05),而成对、二联律房早以及房速的发生明显增加(中位数:4.0 vs 0;3.0 vs 0;1.0 vs 0;P<0.001)。Ⅱ、aVR和V1导联上的P波时限和振幅都明显增加[如Ⅱ导联:(112.73±15.92)ms vs(96.61±14.05)ms;(0.176±0.060)mV vs(0.141±0.050)mV,P均<0.001];P波时限和振幅的异常率亦明显增加(如Ⅱ导联,P波时限≥110 ms,75%vs 24%;P波振幅≥0.25 mV,19%vs 4%,P均<0.01,V1导联,P波时限≥110 ms,24%vs 11%;P波振幅≥0.20 mV,11%vs 0,P均<0.001)。在Ⅱ导联上,1例在房颤开始发作前8个房波为倒置,而在aVR导联上为正向。在V1导联上,P波的形态分布在两组中无明显差异,但在阵发性房颤组中,有2例P波呈完全负向,在房颤发作之前有小于1 000 ms的心房扑动或颤动的发生,而P波时限和振幅均在正常范围之内。结论①阵发性房颤发作后心室率变快;②房颤发作与其发作之前的成对、二联律房早以及房速发作频度增高有关;③房颤发作与P波的时限延长和振幅增高相关;④房颤的发作可能与房间传导径路变化相关。

Objective To explore the basic atrial rhythm characteristics before the onset of paroxysmal atrial fibrillation(PAF),and to understand whether the atrial rhythm characteristics are related to AF.Methods The 8 000 original electronic data from the 24-hour-12-lead electrocardiogram(ECG)database(All the ECG recorder produced by Hangzhou BaihuiMedical Equipment Co)were screened by using the conclusion of'paroxysmal atrial fibrillation'and searching in the corresponding items in the software,finding the data of the corresponding cases,and then numbered and centralized backup.Then the backup cases were analyzed by scatter plot and its reverse technology.After observing the onset rhythm of PAF,a 12-lead ECG was screened at this point to the storage so that the picture was magnified to the appropriate extent by the Windows Photo Viewer to measure the P-wave duration and amplitude ofⅡ,aVR,V1 leads pre-PAF.Then,we counted the average heart rate of sinus rhythm and AF for an hour before and after the occurrence of AF.The number of single premature atrial beats,paired premature atrial beats,bigeminy premature atrial beats and atrial tachycardia occurred in an hour of sinus rhythmwere alsocounted.When PAF cases(PAF group)was determined,gender matching was used to find cases of sinus rhythm with premature atrial beats in the same database(control group)in accord with the PAF group.According to the time of 1 hour before the onset of AF,the sinus heart rate and the corresponding index of atrial ectopic heartbeat were counted at the same time in the control group,then the 12-lead ECG segments were screened and stored,the same method was used to measure the P-wave duration and amplitude ofⅡ、aVR and V1 leads.Results Finally,55 patients(one case which basic rhythm was atrial flutter was excluded)with PAF were enrolled from total of79 patients with PAF while another 56 patients were enrolled as control group.There was no significant difference between the two groups in the age[(68.7±9.8)years old vs(66.2±15.1)years old,P>0.05].The average heart rate increased significantly for an hour after the onset of atrial fibrillation[(99±21)beats/min vs(70±12)beats/min,P<0.001].Compared with the control group,the incidence of paired,bigeminy premature atrial beats and atrial tachycardia increased significantly(median:4.0 vs 0;3.0 vs 0;1.0 vs 0;P<0.001)while there was no significant difference in the single premature atrial beats between the sinus rhythm in the PAF group(median:31.0 vs 43.5,P>0.05).The P-wave duration and amplitude on theⅡ、aVR and V1 leads were significantly increased[Ⅱlead:(112.73±15.92)ms vs(96.61±14.05)ms;(0.176±0.060)mV vs(0.141±0.050)mV,P<0.001];and the mutation rate of P-wave duration and amplitude increased significantly(Ⅱlead,P-wave duration≥110 ms,75%vs 24%;P-wave amplitude≥0.25 mV,19%vs 4%,P<0.01.V1 lead,P-wave duration≥110 ms,24%vs11%;P-wave amplitude≥0.20 mV,11%vs 0,P<0.001).There were 8 inverted atrial P-waves before the episode of AF in theⅡlead while that those were positive in the aVR lead.In the PAF group,two cases were an occurrence of flutter/AF which time of duration were less than 1000 ms before the onset of AF that P-waves were completely negative while the distribution of P-waves were not significantly different between the two groups in the V1 lead and the P-wave duration and amplitude are within the normal range.Conclusions(1)After the onset of PAF,the ventricular rate becomes faster;(2)The episode of AF is related to the increased frequency of paired,bigeminy premature atrial beats and atrial tachycardia.(3)The episode of AF is associated with extended duration and heightened amplitude of P-wave.(4)The episode of AF may be related to the change of interatrial conductive pathways.