动态心电图评价阵发性心房颤动的发作特点

Evaluation of the Episodes of Paroxysmal Atrial Fibrillation by Holter Monitoring

目的 通过分析Holter记录中阵发性心房颤动发作特点 ,探讨阵发性心房颤动反复发作的机理及意义。方法 2 0 0 2年 17月 19例阵发性心房颤动患者 ,平均年龄 (6 8.31± 7.4 8)岁。行动态心电图检查并人工回放 ,记录下列指标 :心房颤动发作时间、发作总次数、房性早搏联律间期、可诱发心房颤动的房性早搏及未诱发心房颤动的房性早搏次数及联律间期。同时采集患者的病史、用药情况及超声心动图结果。结果 30份Holter共记录 2 2 5次心房颤动 (1 2 7次 / 2 4h ,中位数 7次 / 2 4h)。阵发性心房颤动发作在中午和午夜分别有 2个高峰 ,以 12点峰值最明显 ,低谷时间在 16 19点。 15次心房颤动由房性心动过速或心房扑动诱发 ,2 10次心房颤动均由房性早搏诱发。诱发心房颤动的早搏与未诱发心房颤动的早搏相比 ,联律间期缩短 2 5ms(P =0 .0 0 79) ,早搏指数减少 0 .0 3(P =0 .0 12 )。其中 7例(36 .8% ) 97次心房颤动发作均由同一联律间期早搏诱发 ,有 2 3次心房颤动发作前有窦性心动过缓 [(5 2± 6 )次 /min]。结论 2 4h中心房颤动的发作频率存在 2个高峰 ,提示交感 /迷走神经张力可影响心房颤动的反复发生。多数心房颤动发作由固定联律的房性早搏诱发 ,且其联律间期明显短于未诱发心房颤动的房性早搏。

Objective To study the mechanism of repetitive episodes of paroxysmal atrial fibrillation(PAF) through the analysis of characteristics of PAF recorded in Holter monitoring.Methods During Jan to July 2003, 19 patients with PAF, mean age (68.31±7.48) years were enrolled in this study. Holter recordings were analyzed to record the time and number of the episodes of PAF, as well as atrial ectopics preceding episodes of PAF. The atrial ectopic coupling intervals were identified and compared to ectopics occurring remote from atrial fibrillation episodes. Results A total of 225 episodes of sustained atrial fibrillation of 30 Holter records from 19 patients with PAF were analyzed. During the 24 hour period, there were two peaks of episodes in midday and midnight respectively. Fifteen episodes of PAF were induced by atrial flutter or atrial tachycardia, while the other 210 episodes of PAF were associated with atrial ectopics. Atrial ectopics preceding atrial fibrillation were found to be more premature compared to ectopics occurring remote from atrial fibrillation episodes (P = 0.0079), prematurity ratio were decreased 0.03 s (P = 0.012). Overall 36.8 % of the PAF were induced by similar atrial ectopic with the same coupling interval. Twentythree patients had sinus bradycardia immediately before the PAF(average rate 52±6/ min). Conclusion The two peaks of episodes within 24 hours suggested the autonomic tone of sympathetic/vagus nerve is associated with the occurrence of PAF. Paroxysmal atrial fibrillation is preceded by ectopics of a fixed coupling interval, which was shorter than uninvolved atrial ectopics, in a significant proportion of patients.