动态心房超速起搏预防阵发性房颤

目的观察动态心房超速起搏预防阵发性房颤的临床疗效和安全性。方法选择病态窦房结综合症伴阵发性房颤,并需植入永久起搏器的患者8例,分别植入具有动态心房起搏功能的起搏器,PacessetterTrilogy23643例,VitatronSelectionTM900E5例;随访6个月,前3个月不打开动态心房起搏功能,后3个月打开动态心房起搏功能,根据起搏器记录到的模式转换次数和持续时间来判断其预防房颤发作的疗效。结果打开动态心房起搏功能前后,患者房颤发作的次数分别为2437±956次/月和472±135次/月(P<0.05);模式转换持续时间分别为173±105小时/月和48±25小时/月(P<0.05);房颤负荷分别为33±8%和10±7%(P<0.05)。结论动态心房超速起搏,是阵发性房颤预防治疗的有效和安全的方法之一。     

阵发性心房颤动与P波离散度的关系

目的探讨P波离散度(Pd)与阵发性房颤的关系。方法观测62例高血压合并阵发性房颤患者(A组)和63例特发性房颤患者(B组)的pd和p波最大时限(Pmax)。结果两组阵发性房颤患者的Pd和Pmax与对照组比较有显著差异(P<0.05)。AB两组患者之间的Pd和Pmax无显著差异(P>0.05);Pd≥40ms、Pmax≥110ms及二者结合时,预测阵发性房颤患者的敏感性在AB两组结果分别是83.9%、85.5%、77.4%和81.0%、87.3%、79.4%,特异性分别是79.0%、71.0%、90.3%,阳性预测准确度分别是80.0%、74.6%、88.9%和79.7%、75.3%、89.3%。结论Pd是预测阵发性房颤的一个无创而可靠的新指标。     

P波离散度预测阵发性房颤及房性心律失常的价值

目的　探讨体表心电图P波离散度 (Pd)与阵发性 (含特发性 )心房颤动 (AF)及房性心律失常 (AR)的关系。方法　观察测量 5 2例AF和 5 0例AR患者P波离散度、P波最大时限 (Pmax)并与5 0例正常对照组对比分析 ,以上三组均按年龄分为≥ 60岁及 <60岁。结果　两年龄段的AF组、AR组分别与对照组比较则Pmax、Pd均有显著差异 (P <0 0 1) ,AF和AR组在年龄、各指标之间差异无显著性(P >0 0 5 )。Pd≥ 40ms,预测Af的敏感性为 65 % ,特异性为 88% ,阳性预测准确度为 85 % ,Pmax≥110ms ,预测AF敏感性为 75 % ,特异性为 60 % ,阳性预测准确度为 66% ,而当Pmax≥ 110ms+Pd≥ 40ms时 ,预测AF的敏感性及特异性为 44 %、92 % ,阳性预测准确度为 85 %。结论　体表心电图P波离散度是预测AF、AR的一个无创而可靠的新指标     

Value of the atrial signal-averaged electrocardiogram in identifying patients with paroxysmal atrial fibrillation

Atrial signal-averaged electrocardiogram was compared between 25 patients with paroxysmal atrial fibrillation and 20 healthy persons without atrial arrythmias (control). The duration time of the high frequency (50–250 Hz) P wave was significantly (P < 0.01) prolonged in the groups of patients with paroxysmal atrial fibrillation compared with the control group (116 ± 16.4 versus 92 ± 8.1 msec). The diagnostic value of the duration of the high frequency P wave for identifying patients with paroxysmal atrial fibrillation was 104 msec. Using this criterion, a sensitivity of 76% and a specificity of 90% were achieved. Our observation has shown that the atrial signal-averaged electrocardiogram is a useful technique for identifying patients with paroxysmal atrial fibrillation.     

不同部位起搏对阵发性心房颤动患者心房激动时间的影响

目的　比较右心耳 (RAA)、冠状窦远端 (DCS)、右心房双部位 (右心耳加冠状窦口 ,DSA)和双房 (右心耳加冠状窦远端 ,Bi A)起搏对阵发性心房颤动 (PAf)患者心房激动时间的影响。方法 2 2例接受心脏电生理评价试验的PAf患者在窦性心律下行心房不同部位起搏 ,同步记录 12导心电图 ,测量最大 P波时限。结果　与窦性 P波时限相比 ,RAA起搏明显延长 P波时限 (P<0 .0 1) ,DCS、DSA及 Bi A起搏则明显缩短 P波时限 (P<0 .0 1,P<0 .0 1,P<0 .0 1)。结论　 DCS、DSA及 Bi A起搏明显缩短心房激动时间 ,减少心房电活动的离散度 ,有利于 PAf的防治。     

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。     

阵发性心房颤动的昼夜分布节律

目的　观察阵发性心房颤动（房颤）的昼夜分布节律。方法　对阵发房颤的患者进行２４ ｈ动态心电图及持续心电图监测观察其起始、持续和终止的节律变化。结果　３２ 例孤立性阵发性房颤的起始高峰时间４３ 阵（４６．７％ ）发生在午夜至清晨６时。１９ 阵（２０．７％ ）发生在上午６∶００～１２∶００ 时，２１阵（２２．８％ ）发生在１２∶００～１８∶００ 时，９阵（９．８％ ）发生在１８ 时～午夜。持续时间为凌晨４ 时至上午１１时，终止时间为中午及下午。结论　阵发性房颤昼夜分布节律与自主神经及内源性生物活性物质的节律变化有关     

心房肌易损性与阵发性心房颤动的发生机制

目的探讨左、右心房肌复极,及其易损性与阵发性心房颤动(AF)的发生与维持机制。方法应用单相动作电位(MAP)技术记录14只犬左、右心房肌的复极达90%动作电位时程(APD90),通过S1S2程序刺激,同时记录心房有效不应期(ERP)及相对不应期(RRP),观察反复心房激动(RAF,在S1S2的早搏刺激后,发生2个以上的连续心房活动,从心房刺激到RAF第一个激动的间期必须小于250 ms)及AF的诱发。结果14只犬S1S2间期递减至130±32 ms时,可出现RAF,随后当S1S2间期缩短为110±28 ms时AF发作。AF发作前大多数可记录到RAF(66.7%);共诱发出15阵RAF,左房11阵,右房4阵,左房RAF的发生率明显多于右房(P<0.05);共诱发出18阵AF,左房诱发出12阵,右房诱发出6阵。左房的AF诱发率明显多于右房(P<0.05)。结论AF发作前多伴有RAF发作;RAF是易发生阵发性AF的特征性表现,代表心房的易损性;左右心房易损性不同。     

No evidence of automatic atrial overdrive pacing efficacy on reduction of paroxysmal atrial fibrillation.

AIMS: Paroxysmal atrial fibrillation (PAF) is frequently encountered in pacemaker patients, most commonly in sick sinus syndrome. The combination of site-specific pacing in conjunction with an overdrive algorithm combined with antiarrhythmic drugs on the incidence of PAF in patients with a conventional indication for pacing is unknown. METHODS AND RESULTS: Patients with pacemaker indication and PAF received a DDDR-pacemaker, which included an automatic atrial overdrive (AO) algorithm. The atrial lead was implanted in either the right atrial appendage (RAA) (n = 83) or the right low-atrial septum (LAS) (n = 94). The algorithm was switched on or off in a 3 month, single blind crossover design and antiarrhythmic drugs were kept stable. A control group of 96 patients (LAS, n = 14; RAA, n = 84) without PAF served as controls to assess any proarrhythmic effect of overdrive pacing. Atrial fibrillation (AF) burden defined as cumulative time in mode switch was not reduced during automatic AO from either the RAA or from the LAS. The reduction was not effective both for AF of short (<24 h) and long (> or =24 h) duration. There was no atrial proarrhythmia induced by the overdrive algorithm in the control group. CONCLUSIONS: We could not demonstrate a reduction of AF burden defined as cumulative time in AF by the AO algorithm, in patients who are paced for standard indications and PAF, neither from the RAA nor from the LAS.     

An electrocardiogram marker to detect paroxysmal atrial fibrillation

An electrocardiogram marker to detect patients who have paroxysmal atrial fibrillation (PAF) is reported. The data set of ECG records made available by PhysioNet for Cardiology Challenge 2001 was used. The method uses a filtered time series with a frequency range between 3 and 9 Hz obtained from the electrocardiogram record. Typically, frequencies observed when a patient is in atrial fibrillation and atrial flutter is within this frequency range. Filtering was done using wavelets. Thereafter, the temporal properties of this filtered time series are studied. The temporal properties studied are the standard deviation, standard deviation of successive differences, and the length of the ellipse in the Poincare plot. The results indicate that these temporal properties of patients with PAF are depressed compared to the healthy group. A marker based on these temporal properties shows promise in detecting PAF when patients are in normal sinus rhythm. Results also show that the values for these temporal properties for a patient with PAF show little variation with time, and its measure is not dependent on the time of occurrence of a PAF episode.     

An epidemiological study of symptomatic paroxysmal atrial fibrillation in northwest Greece.

AIM: Although atrial fibrillation (AF) is the most commonly sustained arrhythmia, information about its incidence in the general population is sparse. Even more sparse is information on an important variety of AF, paroxysmal AF. The aim of this study is to assess the frequency of new cases of symptomatic paroxysmal AF per year ('incidence') in a general unselected population and to compare other epidemiological features with chronic AF patients. METHODS AND RESULTS: Over a 4 year period, we conducted a prospective, population-based survey of cases of AF in a defined geographical area with a known population size stratified for age and sex. Sources of identification were the two hospitals which serve the area and all the primary care settings. Patients with AF of less than 7 days duration were characterized as paroxysmal AF and all others as chronic AF. During the study period we identified 1551 patients with chronic AF (51.7% male, mean age 71 +/- 10.4 years and 48.3% females, mean age 73.1 +/- 10.8 years) and 443 patients with paroxysmal AF (59.6% male, mean age 59.6 +/- 13.3 years and 40.4% female, mean age 65.2 +/- 10.1 years). There was no underlying cardiovascular disease in 15.6% and 32.3% of patients with chronic and paroxysmal AF, respectively. The mean annual occurrence of new cases of paroxysmal AF was 6.2/10,000/year, and was higher (P<0.01) for men (7.2/10,000/year) than for women (5.3/10,000/year). The frequency of new paroxysmal AF cases rises with age, reaching a peak at 70-79 years and then declines. CONCLUSIONS: We conclude that paroxysmal AF is a relatively common arrhythmia, the occurrence of which increases with age and is more frequent in younger men than in women. Patients with chronic AF are older and more often have underlying heart and other disease than patients with paroxysmal AF.     

Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?

AIMS: To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events. METHODS AND RESULTS: The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients. CONCLUSION: In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation.     

阵发性心房颤动预测因素研究

目的　研究阵发性心房颤动 (PAF)的预测因素。方法　 PAF组 5 9例 ,对照组 31例。同步记录 12导联心电图 ,测量 P波离散度 (Pdis)、P波最大时限 (Pm ax) ;应用超声心动图测量左心房内径 ,计算左室心肌重量指数。结果　与对照组比较 ,PAF组 Pmax、Pdis、左房内径显著增大 (P<0 .0 1) ;Pmax与左房内径和左室心肌重量指数呈正相关 (r =0 .2 6 ,P <0 .0 5 ;r =0 .2 7,P <0 .0 5 ) ;结论　左房内径和 Pm ax为 PAF的独立预测指标 ,P波宽度与左房内径扩大和左室心肌重量指数增加有关。     

莫雷西嗪对阵发性心房颤动的疗效评价

目的 评估莫雷西嗪治疗阵发性心房颤动(房颤)患者的有效性和不良反应以及其对房颤负荷的影响.方法 入选阵发性房颤患者212例,给莫雷西嗪单药干预,并随访观察治疗1、6、12个月后房颤的再发情况、负荷量和不良反应.结果 服用莫雷西嗪1、6、12个月房颤再发率仅34％、32％、35％;用药前与用药后1、6、12个月平均心率,最大心率和最小心率均无明显变化,房颤负荷均有明显下降,并未见死亡和恶性室性心律失常.结论 莫雷西嗪可以作为预防、治疗阵发性房颤发作的选择药物之一.     

阵发性房颤患者P波时限分析指数的研究

目的 对阵发性房颤（PAF）患者P波时限分析指数[包括最大P波时间（Pmax）、最小P波时间（Pmin）、P波离散度（PWD）]进行分析研究,比较其对PAF发生的预测价值.方法 选取50例PAF患者和74名健康对照者,测量同步12导联心电图的P波时限,分别计算两组的P波时限分析指数,并对两组进行比较和统计学分析.结果 PAF组P波时限分析指数Pmax、Pmm和PWD分别为（115.45±9.50）ms、（67.50±11,93）ms和（47.95±14.45）ms,均高于对照组的（96.85±8.80）ms、（62.60±8.98）ms和（34.25±10.80）ms;除Pmm外,Pmax与PWD差异有统计学意义（P＜0.05）.以Pmax≥110 ms、PWD＞40 ms为阳性标准,检测其对PAF的敏感性分别为85.2%、88.5%,特异性分别为88.1%、89.2%.结论 Pmax、PWD对PAF患者具有较高的预测价值.     

Prolonged atrial activity due to delayed conduction in the atrium of patients with paroxysmal atrial fibrillation

Summary We investigated the relationship between the duration of electrical atrial activity and intra-atrial conduction time to determine whether the prolonged atrial activity was due to delayed conduction in the human atrium. The study included 15 patients with paroxysmal atrial fibrillation (PAF) and 15 control patients. The duration of atrial electrical activity was measured by selecting a minimum electrographic amplitude of 50µV. In patients with PAF, the duration of atrial activity was prolonged in proportion to the delay of interatrial conduction time from the high right atrium to the coronary sinus as the coupling interval of premature extrastimuli was decreased. Both the fragmented atrial activity zone and the interatrial conduction delay zone were wider in patients with PAF than in control patients. It is concluded that assessment of the duration of atrial activity with a minimum amplitude of 50µV is useful in evaluating human atrial vulnerability since it reflects the atrial conduction delay in patients with PAF.     

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.     

静脉注射胺碘酮转复阵发性心房颤动的临床观察

目的：观察静脉注射胺碘酮转复阵发性心房颤动（PAF）的疗效和安全性。方法：80例发作1～24h的PAF患者,随机分为两组。胺碘酮组（40例）：胺碘酮150mg静脉注射,继以1mg／min静脉泵入．维持6h,去乙酰毛花苷组（40例）：去乙酰毛花苷0．4mg静脉注射,2h后追加0．2mg。观察PAF转复情况,心率、QTe是期变化及副作用。结果：胺碘酮组复律29例（72％）,去乙酰毛花苷组复律18例（45％）,P〈0．05。复律时间分别为（215±58）min。（253±39）min．P〈0．05。未转复者心率分别下降26％和11％。P〈0．05。QTc间期两组复律前后比较差异无显著性。两组均无严重副作用。结论：静脉注射胺碘酮转复PAF有效且安全。     

稳心颗粒联合比索洛尔治疗老年阵发性心房颤动的临床疗效观察

目的观察稳心颗粒联合比索洛尔治疗老年阵发性心房颤动患者的临床疗效。方法选择102例老年阵发性房颤患者,随机分为两组。一组为对照组,男性38例,女性12例,年龄61-86岁,在常规治疗原发病的基础上给予比索洛尔1．25mg,每日2次,口服,作为起始剂量。另一组为观察组,男性36例,女性16例,年龄62-88岁,在对照组药物治疗基础上加用稳心颗粒9g,每日3次,口服。疗效不佳时两组均将比索洛尔逐渐加至5mg,每日1次,口服。观察治疗前后两组患者每周房颤发作次数、持续时间及服药后的临床疗效,共观察4周。结果药物治疗后两组患者每周房颤发作次数、持续时间均较治疗前明显减少,差异有统计学意义（P〈0．01）,且观察组较对照组变化明显,差异有统计学意义（P〈O．05）;临床总有效率观察组高于对照组,差异有统计学意义（P〈O．05）。结论稳心颗粒治疗老年阵发性房颤有效,联合比索洛尔治疗,疗效优于单用比索洛尔。     

阵发性心房颤动患者心房内阻滞的评价

目的对阵发性心房颤动(房颤)患者心房内阻滞的情况进行评价.方法入选78例阵发性房颤患者和8创无阵发性房颤的射频消融患者,电生理检查时分别放置高位右心房、希氏束、冠状静脉窦电极导管作起搏和标测用,在高位右心房进行S1S2程序刺激,S1刺激固定于500ms,S2从450ms开始,-10ms扫描,记录不同刺激时心房内和心房间传导时间及心房不应期.结果S1刺激时阵发性房颤组和对照组S1-AHB间期分别为(56.7±15.4)ms和(60.8±14.2)ms;S1-ACSd间期在两组分别为(110.2±24.3)ms和(107.5±25.6)ms;差异均无显著性(P＞0.05).S2刺激时,心房内传导时间最长延长1倍以上的患者在两组分别为15/78例和11/80例,心房间传导最长延长1倍以上的患者在两组间分别为13/78例和9/80例,两组间差异无显著性(P＞0.05).心房不应期在两组分别为(218.0±28.2)ms和(216.0±24.7)ms,两者间差异无显著性(P＞0.05).结论多数阵发性房颤患者无明显的心房内阻滞和不应期改变,传导时间延长也并非特异地发生在阵发性房颤组,提示心房内阻滞和不应期缩短在阵发性房颤的发生中的作用尚不明确.