阵发性心房颤动初始节律的动态心电图观察.docVIP

阵发性心房颤动初始节律的动态心电图观察 　　作者：王兴德,蒋兆华,韩晓勤,谷守明　　作者单位：200125 上海，上海市浦南医院 　　【摘要】目的观察阵发性心房颤动(PAf) 初始节律的心电触发因素及其部位，并探讨其临床意义。方法 对50例PAf 患者的动态心电图进行人工回放，记录心房颤动(Af) 发作次数、发作前三个心房周期及联律间期和发作前120s和30s内的房性期前收缩数，并根据触发Af 的房性期前收缩的P波形态确定房性期前收缩部位。结果 50例PAf 患者共290次Af 发作，心电触发因素中房性期前收缩占862%，窦性心动过缓占758%，心房扑动占275%，房性心动过速占345%;房性期前收缩来源于左心房上部占712%，左心房下部占120%，右心房上部占100%，右心房下部占20%，不能定位占48%;触发Af 的房性期前收缩比未触发Af 的房性期前收缩的联律间期缩短40ms以上;在PAf 发作前120s和前30s期间内房性早搏发生频率由11次min分别增加到42次min和64次min。结论 房性期前收缩是PAf最主要的触发因素，长-短周期现象是PAf 发作的重要启动机制， 12导联动态心电图作为一种无创性的检查方法对阵发性房颤的临床诊治有重要的参考价值。 　　【关键词】 动态心电图,阵发性心房颤动,触发方式;房性期前收缩 　　[Abstract] Objective To explore the touching off factors and sites of paroxysmal atrial fibrillation (PAF) and their clinical significance Methods Artificially replay the Dynamic electrocardiogram of 50 cases of PAF to record the time of atrial fibrillation (AF) and identify the site of atrial premature beat (APB)Results There were 290 attach in 50 cases The factors that trigger PAF included APB 8620%, sinus bradycardia 758%, atrial flutter 275% and tachycardia 345% The sources of APB include upper left atrial 712%, lower left atrial 120%, upper right atrial 100% and lower right atrial 20% The coupling interval of APBs of triggering PAF was shorter over 40ms than that of ones without triggering PAF In the 120 seconds or 30 seconds before onset of PAF frequency of ectopic beats increased from 11min to 42min or 64min Conclusion Upper left APB is the major touching factor of PAF Long and short cycle is an important initiating mechanism Dynamic electrocardiogram is very helpful for the diagnosis and treatment of PAF 　　[Key words] dynamic electrocardiogram; paroxysmal atrial fibrillation; electrocardiograph triggering; atrial premature beat 　　心房颤动(Atrial fibrillation，Af) 是临床常见的心律失常，其主要危害在于血管栓塞并发症及心功能损害。阵发性心房颤动(Paroxysmal atrial fibrillation，PAf) 是持续性Af 的前期表现，随PAf 反复发作，PAf 发作次数增加，持续时间延长，最终进展为持续性Af 。预防PAf 发作，关键在于了解PAf 发作的触发因素及其机制。本文通过十二通道动态心电图观察PAf 发作的心电触