短阵房性心动过速发生规律及其昼夜节律的临床意义

目的 探讨短阵房性心动过速发生规律及其昼夜节律的临床意义.方法 应用动态心电图对366例短阵房性心动过速发生规律及其昼夜节律进行监测与分析.结果 短阵房性心动过速以冠心病的发生率最高(55.2％);检出率随年龄增长而增加,老年组检出率最高,与其他年龄组比较差异有统计学意义(P＜0.01);房性心动过速发作存在昼夜节律(2个高峰和1个低谷).结论 冠心病患者受到心房肌缺血、缺氧、炎症、变性、纤维化等多种因素影响,使心房肌除极速度不一致,利于短阵房性心动过速的发生;短阵房性心动过速的检出率随年龄增长呈上升趋势,主要因素与心房肌退行性变引起心脏自律性、兴奋性及传导性发生改变有关;短阵房性心动过速存在昼夜节律,提示受植物神经的影响.     

阵发性心房颤动的动态心电图特征研究

目的 探讨阵发性心房颤动发生的动态心电图特征. 方法 对38例阵发性心房颤动患者和24例非阵发性心房颤动患者的动态心电图进行分析,测定和计算房性期前收缩偶联间期和房性期前收缩指数. 结果 阵发性心房颤动共发作291次,其中221次由房性期前收缩诱发（75.95%）.诱发心房颤动的房性期前收缩与未诱发心房颤动的房性期前收缩比较,偶联间期较短,期前收缩指数较小,差异有统计学意义（P〈0.05）.心房颤动发作前1h房性期前收缩和短阵房性心动过速频率增加.35.75%阵发性心房颤动发生时出现明显的长短周期现象. 结论 房性期前收缩是阵发性心房颤动发生的主要因素,长短周期现象是阵发性心房颤动发生的重要电生理机制.     

阵发性心房颤动的动态心电图分析

目的探讨动态心电图对阵发性心房颤动诊断和疗效判断的意义。方法分析78例阵发性心房颤动患者和80例对照组的24h动态心电图。统计单个期前收缩总数、心房颤动的频率和持续时间、心房颤动相关的偶联间期、非心房颤动患者房性期前收缩的偶联间期及24h房性期前收缩总数。结果心房颤动组:共发作33314阵心房颤动,其中36例11173阵发生在8∶00至22∶00,74例22141阵发生在22∶00至8∶00。平均24h房性期前收缩8242±1245个,心房颤动456±122阵。诱发心房颤动的,17例为单一房性期前收缩的偶联间期,33例为两种房性期前收缩的偶联间期,28例为两种以上房性期前收缩的偶联间期。发作前与发作相关的房性期前收缩偶联间期为0.429±0.089s,54例房性期前收缩伴心室内差异性传导,平均心率175±41次/min,64例6284阵心房颤动时伴有心悸、胸闷等症状,而69例27026阵发作时前无明显症状。对照组无心房颤动发生,35例有短阵房性心动过速,24例有频发房性期前收缩,56例有偶发房性期前收缩,房性期前收缩偶联间期0.633±0.014s,明显长于心房颤动组发作前与心房颤动相关的房性期前收缩及未下传的房性期前收缩偶联间期(P<0.01)。结论动态心电图监测是阵发性心房颤动诊断和疗效评价方面可靠、高效、重复性好的检查手段。     

阵发性心房纤颤患者发病原因及动态心电图分析

目的探讨心房纤颤患者的发病原因及动态心电图特点。方法回顾性分析32例阵发性心房纤颤患者的临床资料及动态心电图特点。结果 32例患者中器质性心脏病31例;有频发房性早搏及短阵房速者24例,其中有房性早搏未下传者4例,房性早搏未下传者发作阵发性房颤频率更高,持续时间更长;常规心电图发现,未发生阵发性房颤时心电图表现左房室瓣型P波者9例(28%),其中高血压患者有7例。结论阵发性心房纤颤的主要病因是原发病,房性期前收缩是阵发性心房纤颤的主要因素;不全性心房内传导阻滞及左房扩大是高血压患者易发生心房纤颤的病理学基础;未下传的房性期前收缩造成的长短周期现象是阵发性心房纤颤的重要电生理机制。     

阵发性房性心动过速动态心电图临床分析

目的 探讨短阵房性心动过速(PAT)的临床意义.方法 对146例PAT的动态心电图进行分析.结果 确诊为心血管疾病者(A组)PAT的检出率随年龄而增加,且其发生频率明显高于健康检查或仅有胸闷、心悸、乏力以及心脏以外其他疾病者(B组).差异有统计学意义(P<0.01).结论 动态心电图对PAT的诊断和治疗具有临床意义.     

动态心电图和常规心电图对老年无症状性心肌缺血的诊断价值

目的探讨动态心电图和常规心电图对老年无症状性心肌缺血(SMI)的诊断价值。方法采用动态心电图和常规心电图对207例老年心律失常病人进行监测,比较两种心电图对SMI的诊断效果。结果动态心电图对老年SMI的检出率为72.95%,高于常规心电图的30.92%,差异有统计学意义(P0.05)。老年SMI发作呈明显的昼夜节律,快频率依赖型SMI与慢频率依赖型SMI的发生次数及持续时间比较,差异均有统计学意义(P0.05)。两种心电图检出的室性期前收缩及房性期前收缩比较,差异均有统计学意义(P0.05)。结论动态心电图比常规心电图更能准确地反映老年SMI病人的发病特点和规律。     

12导联动态心电图与常规心电图对老年冠心病病人无症状心肌缺血和心律失常的诊断价值

目的探究12导联动态心电图与常规心电图对老年冠心病病人无症状心肌缺血及心律失常的诊断价值。方法选取昆山市第四人民医院2015年12月—2016年12月收治的老年冠心病病人86例,均给予常规心电图及12导联动态心电图检查,比较两种诊断方式检测无症状心肌缺血及各类型心律失常的检出率,并观察心肌缺血发作时间分布情况。结果 12导联动态心电图的无症状心肌缺血检出率显著高于常规心电图,差异有统计学意义(P0.05)。有症状、无症状心肌缺血的发作频率最高时间均为06:00～12:00,其次为12:00～18:00。12导联动态心电图的室性心律失常和房性心律失常的期前收缩二、三联律及成对期前收缩、短阵室上性心动过速、房室传导阻滞检出率均高于常规心电图,差异有统计学意义(P 0.05)。结论 12导联动态心电图相比于常规心电图对老年冠心病病人无症状心肌缺血及心律失常的检测价值更高。     

长RP心动过速的动态心电图研究

目的探讨长RP心动过速的动态心电图表现及其鉴别诊断依据。方法采用12通道动态心电图记录仪对35例长RP心动过速患者进行监测,对心动过速发作时的诱发及终止状态、持续时间、频率,P波极性及临床特点等方面进行对比分析。结果持续性房室折返性心动过速(PAVRT)、房性心动过速(AT)及快-慢型房室结折返性心动过速(F-S-AVNRT)三组患者中,心动过速发生时P波于Ⅱ、Ⅲ、a VF导联倒置,a VR导联直立,RP间期均>PR间期。6例PAVRT发作时均呈无休止状态,心动过速发作占24 h总心跳的32.8%~50.0%,由室早诱发,发作时频率110~160次/min。15例房速均由房早诱发,发作阵数在1~186阵,发作时频率107~150次/min;两例F-S-AVNRT由房早伴PR间期延长所诱发,发作时频率127~182次/min。12例房扑伴2∶1房室传导由房早诱发,发作时心室率120~165次/min,符合Bix定律时心室率150次/min。结论动态心电图监测对长RP心动过速发作时的诱发及终止状态、持续时间、频率等有鉴别诊断意义,有助于诊断长RP心动过速。     

房性期前收缩诱发阵发性心房颤动患者动态心电图与心脏彩超检查的临床分析

目的对房性期前收缩诱发阵发性心房颤动(房颤)患者动态心电图(DCG)与心脏彩超(PAF)检查结果进行临床分析。方法选择55例阵发性房颤患者与55例非阵发性房颤患者的动态心电图与心脏彩超检查结果进行比较分析,并经彩超检查测量左房大小。结果阵发性房颤组24小时房性期前收缩发生次数明显多于对照组;引发房颤的房性期前收缩联律间期明显短于对照组房性期前收缩联律间期;房颤组组内数据相比,引发房颤的房性期前收缩联律间期短于房颤发作前最近一次单发的房性期前收缩的联律间期;房颤组左房内径与对照组比较差异无统计学意义,但对于房颤持续时间大于1h的患者,其左房内径明显大于对照组。结论阵发性房颤的发作和维持与房性期前收缩的提早量以及发生频率、左心房的大小及自主神经的调控能力等有密切关系。阵发性房颤维持时间的长短与心房增大的程度亦有临床意义。     

无症状短阵房性心动过速的时间规律与机制

应用24小时动态心电图观察以心脏病为主的连续1128例病人,发现无症状短程阵发性房性心动过速(PAT)共279例,检出率24.7％。其时间规律为夜间少,白天逐渐增多,中午达高峰,集中趋势在12点48分。非卧床状态下发生阵数是卧床休息状态下的二倍。检出率随年龄而增加。大部分PAT为自律性心律失常,提示植物神经通过体液因素影响其时间规律。     

阵发性心房颤动的动态心电图分析

目的 通过24 h动态心电图观察阵发性心房颤动,分析阵发性心房颤动的发作特点.方法 对32例阵发性心房颤动患者的24 h心房颤动的发生、持续时间和次数进行统计.结果 32例阵发性心房颤动患者心房颤动的发生和持续时间均有2个高峰,发生高峰在0∶00～1∶00和15∶00～16∶00,持续高峰在2∶00～4∶00和16∶00～18∶00时间段,终止高峰在8∶00～10∶00.结论 阵发性心房颤动的发作、持续均有2个高峰期,有着昼夜节律性规律,夜间发作多见于无器质性心脏疾病、年龄偏小、男性患者,持续时间较长的阵发性心房颤动多见于有器质性心脏疾病、老年患者.     

酷似阵发性室上性心动过速的心房扑动的心电图特点和诊断

目的：分析酷似阵发性室上性心动过速的心房扑动的心电图并探索其有效诊断方法。方法：选择我院1998~2010年门诊及住院酷似阵发性室上性心动过速的心房扑动病例资料26例,分析其特点及诊断方法价值。结果：（1）心电图特点：F波在Ⅱ、Ⅲ、aVF导联显现25例（96.2%）,在V1导联显现22例;F波在Ⅱ、Ⅲ、aVF导联呈负向22例（84.6%）,呈正向2例,难以辨别方向2例;F波在全部导联中的最大振幅≤0.2mV者5例;F波全部与QRS波和T波融合并使形态发生了变化;（2）诊断根据：①使用工具（分规,放大镜等）主动寻找F波,有25例（96.2%）发现可疑F波;②结合病史,均有器质性心脏病（100%）,9例（34.6%）有阵发性心房颤动史;③与发作前的心电图对照,15例（57.7%）发现有确切F波;④兴奋迷走神经（Valsalva动作等）：适合检查者20例,16例（61.5%,16/26）房室传导比例发生改变,得以确诊;⑤食道心电图：根据心电图诊断20例（76.9%）,余6例（23.1%）可疑者经食道心电图明确诊断。结论：上述方法联合使用,并综合判断可提高心房扑动诊断的准确性。     

Regular ventricular rhythms in patients with symptomatic paroxysmal atrial fibrillation

Paroxysmal atrial fibrillation is a grossly irregular tachycardia. Forty-nine patients with paroxysmal atrial fibrillation who were taking a variety of antiarrhythmic medications including the class IC agents propafenone and flecainide were followed up for a median of 371 days with use of transtelephonic electrocardiogram (ECG) monitoring to document symptomatic rhythms. Eighteen patients had 96 episodes of regular tachycardia; the cumulative incidence rate was 25% at 6 months, 33% at 1 year and 41% at 18 months. Eighty of the 96 episodes occurred with a heart rate less than or equal to 180 beats/min and could have been explained by atrial flutter with 2:1 block. However, nine patients had a total of 16 episodes with a rate greater than 180 beats/min that were probably not due to atrial flutter with block; the cumulative incidence rate of these fast regular tachycardias was 14% at 6 months, 17% at 1 year and 25% at 18 months. QRS duration during the first episode of regular tachycardia was significantly longer in patients taking a class IC drug (median 105 vs 90 ms, p less than 0.001 Wilcoxon rank sum test). In contrast to drug therapy with amiodarone or the combination of digoxin and verapamil, the QRS duration of regular tachycardias during class IC therapy was directly related to the tachycardia heart rate (Spearman's rank, p less than 0.01). All episodes of fast, regular tachycardias with a QRS duration greater than 120 ms occurred in patients taking a class IC drug. Clinicians treating patients with paroxysmal atrial fibrillation should expect a substantial incidence of regular tachycardia in addition to atrial fibrillation.     

Holter monitoring in patients with mitral stenosis and sinus rhythm

To determine the type and frequency of supraventricular arrhythmias in patients with mitral stenosis and sinus rhythm we studied 63 such patients, mean (sd) age 48.8 (8.2) years, by 24 hour ambulatory ECG monitoring. Thirty-five patients (55.6%) had supraventricular tachyarrhythmias. Twenty-five (39.7%) had paroxysmal atrial tachycardia, 14 (22.2%) atrial fibrillation, 8 (12.7%) multifocal atrial tachycardia and 5 atrial flutter. Ninety-five per cent (101) of episodes were asymptomatic and 96% non-sustained. Supraventricular premature beats occurred in 59 patients with couplets and triplets in 40 (63.5%) and 28 (44.4%), respectively. Frequent supraventricular premature beats, couplets, triplets and episodes of paroxysmal arrhythmias were commoner in patients greater than 50 years. Ectopic atrial rhythms with varying P wave morphology occurred in 12 patients (19%). Nine patients (14.3%) had suffered systemic embolic episodes. We conclude that supraventricular ectopic and tachyarrhythmias occur frequently in patients with mitral stenosis and sinus rhythm and that most paroxysms are non-sustained and asymptomatic.     

动态心电图与常规心电图在临床心脏病诊断中的应用价值对比

目的比较临床心脏病诊断过程中采用动态心电图与常规心电图的应用价值。方法选取我院2010年12月—2012年12月收治的并实施心电图检查的患者322例,对患者的心电图资料进行回顾性分析。结果采用动态心电图监测室上性期前收缩、室性期前收缩、阵发性室上性心动过速、阵发性心房纤颤、窦性心动过速、窦性心动过缓、阵发性房速、室性心动过速、窦性静止与窦房传导阻滞检出率高于采用常规心电图检查(P0.05);其中≥70岁年龄段患者窦性静止与窦房传导阻滞和房室传导阻滞检出率高于其他年龄段患者(P0.05)。结论在临床心脏病诊断过程中采用动态心电图监测较常规心电图检查,临床诊断效果更为显著,因此采用动态心电图监测是临床诊断心脏病的理想选择,同时更应该针对老年患者实施动态心电图监测。     

房室折返性心动过速合并阵发性心房颤动的射频导管消融策略

目的探讨房室折返性心动过速（AVRT）合并阵发性心房颤动的射频导管消融（下称消融）策略。方法对经电生理检查证实的AVRT患者15例行旁道消融术,其中男性9例,女性6例,并对术后心房颤动的转归进行12～36个月的随访,观察心房颤动发生、持续时间、有无心律失常等情况。结果13例未再发生心房颤动,2例有严重器质性心脏病的患者仍有阵发性心房颤动复发,但发作次数明显减少,口服胺碘酮可控制症状。1例动态心电图示频发房性期前收缩。结论AVRT与阵发性心房颤动发生率增高密切相关,AVRT是心房颤动的触发因素。旁道消融后,阵发性心房颤动可明显改善,未改善者与心房扩大等心房基质未改善有关。     

食管心房调搏诱发与终止房室折返性心动过速的研究

目的探讨经食管心房调搏诱发与终止房室折返性心动过速的价值。方法选择255例有心动过速发作史,并且既往心电图证实有阵发性室上性心动过速(PSVT)的患者行食管心房调搏检查。结果在被检的255例患者中诱发房室折返性心动过速229例,占89.8%(其中顺向型217例,占94.8%,逆向型12例,占5.2%)。诱发成功的最佳刺激方法为程序期前刺激法(S1S2、S1S2S3),诱发率为88.2%。诱发的必备条件是旁路有效不应期长于房室结有效不应期。在诱发房室折返性心动过速的229例中215例经电刺激成功终止,转复为窦性心律,成功率为93.9%,其中64例采用短阵快速刺激一次性成功终止,转复成功率达100%。结论食管心房调搏能有效地诱发与终止房室折返性心动过速,诱发顺向型房室折返性心动过速的关键因素是旁路不应期大于房室结有效不应期,终止发作的最有效的刺激方法为短阵快速刺激。本法可作为急诊终止阵发性室上性心动过速的首选方法。     

Non-invasive evaluation of a population with WPW syndrome]

OBJECTIVE: Evaluation of a WPW Syndrome population by non invasive methods; identification of the sudden death risk; results of treatment and patient selection for Electrophysiologic Studies (EPS). DESIGN: Retrospective study. SETTING: Arrhythmology Outpatients Clinic from a Cardiac Department. PATIENTS: Successive patients older than 12 years with a WPW pattern on the ECG and history of paroxysmal tachycardia followed-up for a period of 46 +/- 29 months. MATERIAL AND METHODS: The clinical, ECG, Holter, stress test and echocardiographic data from 32 patients, were analysed. A study evaluating clinical follow up and the results of treatment was done. RESULTS: The group of patients was very symptomatic. The main complaint was a feeling of tachycardia (84.4%). Orthodromic tachycardia was documented in 7 cases and atrial fibrillation with rapid ventricular rate in five. Intermittent delta wave pattern was found in 21 patients, with 11 cases identified by Holter and 4 by stress test. A predominant left accessory pathway was found (47%), but the anteroseptal location was frequent too (25%). The echocardiogram was not useful in any case. Eighty per cent of the patients became asymptomatic with medical treatment. Beta blockers and amiodarone (the last chance) were the most useful drugs. No mortality was found in the study group. EPS was considered for the 5 patients with paroxysmal atrial fibrillation and the 7 cases resistant to medical treatment. CONCLUSIONS: The difficulty to define the risk of a population with WPW Syndrome by non invasive methods was demonstrated. Eighteen one cases were included in a low risk group, due to the intermittent WPW pattern in the ECG. A high risk group was considered for the 5 patients with atrial fibrillation with fast ventricular rate. The risk was not established in 9 cases. Most of the patients became asymptomatic by medical treatment.     

Long-term therapy with disopyramide phosphate: side effects and effectiveness

In this study, the safety and efficacy of long-term therapy with disopyramide phosphate were evaluated in 40 patients with documented, recurrent, symptomatic tachyarrhythmias. Twenty-one (53%) of the patients had organic heart disease, and nine of these patients had compensated congestive heart failure. The tachyarrhythmias which were treated were paroxysmal supraventricular tachycardia (21 patients), paroxysmal atrial fibrillation (six patients), and paroxysmal ventricular tachycardia (13 patients). In each patient there was evidence, from continuous ECG monitoring or electrophysiologic testing, that disopyramide would be effective therapy, and each patient was able to tolerate disopyramide (no side effects or tolerable side effects) during an initial trial period of 1 to 2 weeks. Dosages of disopyramide were 400 to 1600 mg/day (994 +/- 320 mm/day). During long-term therapy, side effects were reported by 28 (70%) of the patients. The side effects were usually anticholinergic, and were usually a continuation of side effects noted during the initial trial period. None of the patients had idiosyncratic reactions to disopyramide. Most of the patients found side effects to be tolerable; however, in seven patients it was necessary to discontinue disopyramide after 1 to 8 (6 +/- 3) months. Actuarial incidence of intolerable side effects was 21 +/- 7% at 12 months. Nine (22%) of the 40 patients had symptomatic recurrences of tachyarrhythmia after 3 to 32 (15 +/- 9) months of therapy. Actuarial incidence of drug ineffectiveness was 32 +/- 10% at 24 months. Disopyramide was both effective and tolerated in 24 (60%) of the patients, who were followed for 2 to 64 (23 +/- 16) months.(ABSTRACT TRUNCATED AT 250 WORDS)     

自发转复阵发性心房颤动100例P波离散度分析

目的探讨P波离散度（P wave dispersion，PD）预测伴器质性心脏病的阵发性心房颤动。方法自发转复阵发性心房颤动100例分为3组，孤立性心房颤动组：无器质性心脏病，年龄在60岁或以上42例。器质性心房颤动组：阵发性心房颤动伴器质性心脏病，58例，其中年龄小于60岁（包括60岁）20例，年龄超过60岁38例。对照组80例，无器质性心脏病及阵发性心房颤动，其中，年龄小于60岁（包括60岁）43例，年龄超过60岁37例。用SR-1000C型心电综合分析仪同步测量12导联心电图P波最大波宽（Pmax）、P波最小波宽度（Pmin）和PD。结果Pmax和Pmin在孤立性心房颤动组、器质性心房颤动组与对照组的年龄比较，差异无统计学意义（P〉0．05），然而Pmax与PD在器质性心房颤动组与对照组之间差异有统计学意义（P〈0．05）。结论PD可预测孤立性心房颤动和器质性阵发性心房颤动的无创而可靠指标。