心房颤动伴长R-R间期的临床意义

目的 探讨心房颤动伴长R-R间期的临床意义.方法 记录204例心房颤动患者环肺静脉隔离术（CPVA）前后的动态心电图,根据患者术后恢复窦性心律后的动态心电图有无二度房室传导阻滞分为：无二度房室传导阻滞组（A组）及二度房室传导阻滞组（B组）,分析两组平均心率、长R-R间期及逸搏心律的平均次数及R-R间期、逸搏心律的分布规律.结果 204例（A组193例,B组11例）心房颤动患者CPVA术后均成功转为窦性心律,两组R-R间期＞2.0s、R-R间期＞2.7s及逸搏心律平均次数比较,差异均有统计学意义（均P＜0.05）.A组中R-R间期＞2.0s及逸搏心律的分布与睡眠或休息有关,而B组中则日夜均可见.结论 不能单纯根据长R-R间期诊断心房颤动伴二度房室传导阻滞,只有R-R间期＞2.0s明显增多并出现R-R间期＞2.7s且心室率＜35 次 / min的逸搏心律（与睡眠或休息无关或伴有器质性心脏病）时,心房颤动伴二度房室传导阻滞的诊断才可能成立.

Clinical Significance of Long R-R Intervals during Atrial Fibrillation

Objective To investigate clinical significance of long RR intervals during atrial fibrillation（Af）. Methods Dy- namic electrocardiogram （DCG） was recorded in 204 patients with AF before and after successful circumferential pulmonary vein ablation （CPVA）. All patients were divided into group A without and group B with second-degree of atrioventricular block during sinus rhythm on DCG after CPVA. The average heart rate, the incidence and distribution of long RR interval and escape rhythm were analyzed. Results The incidence of R-R interval 〉 2.0s, R-R interval 〉 2.7s and escape rhythm were significantly different between two groups （P 〈 0.05）. Escape rhythm and long R-R interval 〉 2.0s occurred mostly during sleep and rest in group A, but both day and night in group B. Conclusion The diagnosis of second-degree of atrioventricular block may only be established by the presence of frequent R-R interval 〉 2.0s, R-R interval 〉 2.7s with a ventricular escape rhythm of 〈 35 beats per minute unrelated to sleep and rest in patients with AF.