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。     

长程动态心电图在脑梗塞患者的应用

目的探讨长时程动态心电图诊断脑梗塞患者阵发性房颤的临床价值。方法随机从2018年1月～2019年8月我院收治脑梗塞患者中择取42例为研究对象。全部患者均接受普通心电图检查、24h动态心电图检查和长时程动态心电图检查,比较观察三种心电图阵发性房颤等心律失常检出率。结果长时程动态心电图检出室性早搏21.43%、短阵室速7.14%、ST-T改变9.52%,高于普通心电图检出率(p0.05),检出阵发性房颤16.67%、房性早搏35.71%、房性心动过速23.81%,高于普通心电图与24h动态心电图检出率(p0.05)。结论脑梗塞的发生与房颤有关,长时程动态心电图监控能够有效发现阵发性房颤,其检出率高,效果优于普通心电图和24h动态心电图,能够为脑梗塞治疗及二次预防提供更有价值的依据,有助于减少脑梗塞复发,值得临床使用推广。     

器质性心脏病伴阵发性房颤动态心电图的结果分析

目的探讨器质性心脏病伴阵发性房颤动态心电图。方法选取2017年2月至2018年11月收治的32例器质性心脏病伴阵发性房颤患者作为研究对象,同期选择32例阵发性房颤患者(无器质性心脏病)作为研究对象,观察64例受检人员经动态心电图检查后平均记录时间、平均阵发性房颤发作次数、平均每次阵发性房颤发作时间、平均心室率,且分析引起阵发性房颤诱因。结果观察组与对照组的平均记录时间、平均阵发性房颤发作次数、平均每次阵发性房颤发作时间、平均心室率相比,无明显差异(P0.05)。观察组经动态心电图检查后发现由房性早搏所引起的阵发性房颤共3405次,而对照组经房性早搏所引起的阵发性房颤共569次,两组相比存在明显差异(P0.05)。结论在临床上借助动态心电图检查阵发性房颤十分重要,可为初步判断房性早搏来源提供客观依据,同时也是判断阵发性房颤的主要方法之一。     

诱发阵发性房颤的房性早搏的某些特征

目的通过12导联动态心电图（12-HOLTER）检查对阵发性房颤（paroxysmalatrialfibrillation,PAF）及其相关的房性心律失常进行检测分析,探讨PAF发生的触发因素。方法选择PAF组（n=47例,男20例,女27例,年龄64.89±12.70岁,其中房性早搏诱发PAF为诱发PAF组,房性早搏未诱发PAF为未诱发PAF组）及对照组（n=52例,男22例,女30例,年龄65.54±9.94岁）,分别行12-HOLTER检测,分析PAF及相关的房性心律失常的心电图特征,探讨PAF触发机制。结果①12-HOLTER共检出PAF72阵/次;②PAF多由房性早搏诱发（91%）,偶突然发生（8%）或由心房扑动所诱发（1%）;③诱发PAF组的房性早搏联律间期较未诱发PAF组及对照组明显缩短（490±90ms,590±140ms,630±90ms,p〈0.05）,房早指数明显较小（0.52±0.12,0.62±0.09,0.71±0.06,p〈0.05）;诱发PAF组的房早前周期较对照组明显延长（990±280ms,940±210ms,p〈0.05）;④PAF发作前2min至30s内,房性早搏频度明显增大（0.43次/分～6.00次/分,p=0.000）;⑤诱发PAF组的心电长-短周期现象发生率明显高于未诱发PAF组及对照组（50.63%,30.56%,9.72%,p〈0.001）;⑥诱发PAF的房性早搏多起源于左心房上部（77%）。结论①12-HOLTER可应用于阵发性房颤的检测与诊断,并可对诱发PAF的房性心律失常进行定量检测分析;②房性早搏是PAF的主要诱发因素;③诱发PAF的房性早搏联律间期较短,房早指数较小,房早前周期明显延长;PAF发生前多可见心电长-短周期现象;④阵发性房颤发生前30s至2min内房性早搏频度明显增大;⑤诱发PAF的房性早搏多起源于左心房上部。     

动态心电图在房性早搏诱发阵发性心房颤动诊断中的应用

目的研究动态心电图在房性早搏诱发阵发性心房颤动中的应用，并分析阵发性心房颤动和房性早搏的关系。方法选取我院2010年1月至2013年2月收治的48例阵发性房颤动患者，所有患者经动态心电图确诊。分析48例患者阵发性房颤次数、诱发房颤的房早前周期、房早联律间期，未诱发房颤的房早间期及房早前周期。结果诱发房颤的房早联律间期为（814±102）ms，未诱发房颤的房早间联律间期为（710±124）ms，诱发比未诱发明显提前，两组比较差异具有统计学意义（P〈0．05）；诱发房颤的房早联律间期为（325．8±34．5）ms，未诱发房颤的房早联律间期为（510．2±38．5）ms，诱发比未诱发明显短，两组比较差异具有统计学意义（P〈0．05）。结论房性早搏联律间期与房性早搏始动及房早前周期有一定的关系，动态心电图在诊断阵发性心房颤动中具有无创、高效、可靠、重复性好等优点。     

阵发性心房颤动发作特点的研究

目的：分析阵发性心房颤动（房颤）的发作特点。方法：42例阵发性房颤患者分成有器质性心脏病和无可发现的器质性心脏病2例,共进行45次24h动态心电图检查,对比房颤发作前30min和1min的窦性心室率,以及诱发和不诱发房颤的房性早搏的配对间期（PP′）和早搏指数（PI）。结果：随机抽取53例次的阵发性房颤样本。房颤发作前30min和1min的平均窦性心室率改变不显著。但14例次（33％）和15例次（36％）房颤发作前1min的窦性心室率＜60次／min,与53个不诱发房颤的房性早搏相比。48个诱发房颤的房性早搏的PP′间期和PI均显著缩短（P＜0．001）。有器质性心脏病和无器质性心脏病的2组阵发性房颤患者的各项观察指标差异均显著性。结论：短配对间期的房性早搏是阵发性房颤的独立诱发因素,部分患者的房颤发作与心动过缓有关,采取相应的治疗措可能预防房颤的发生。     

长短周期现象诱发阵发性房颤2例

例 1:男 ,既往有频发房性早搏二联律及阵发性心房纤颤病史。动态心电图示频发的房性早搏二联律 ,一次联律间期较短的房性早搏与其前一个房性早搏的代偿间期形成长短周期现象 ,诱发了心房纤颤。例 2 :女 ,心电图诊断病态窦房结综合征、慢快综合征。动态心电图示开始为缓慢窦性心     

阵发性房颤心房易颤期时限的探讨

对32例阵发性短阵性房颤动态心电图的观察,发现房颤发生前均有房性早搏出现,而且呈进行性增多,甚至呈联律;诱发房颤的房早多出现在前一心动周期的收缩中期,且诱发房颤的房早 P 波落在 ST 段上及 T 波升肢时限内占87.6%。提出心房易颤期可能不在 R 波降肢至 S 波时限内,而是位于 ST 段至 T 波升肢时限内。     

心房颤动与长短周期现象

心房颤动 (房颤 )的发生机制较为复杂 ,许多研究发现自主神经在房颤 ,尤其在阵发性房颤的发生中起重要作用。Coumel等将阵发性房颤分为迷走神经介导和交感神经介导性房颤两种 ,神经介导的阵发性房颤可以不伴有器质性心脏病。近年来发现阵发性房颤的发生与长短周期现象 (long -cycle -short-cycle - phenomenon)有关 ,在电生理检查及动态心电图检测中也证实了这一看法一、长短周期现象引发心房颤动的电生理机制1、心房肌中自主神经分布十分丰富 ,其电生理特性受自主神经影响较大 ,刺激迷走神经可使心房有效不应期缩短 ,发生的微折返的波长也…     

动态心电图对房性早搏诱发的阵发性心房颤动的诊断价值

目的探讨阵发性心房颤动与房性早搏的关系。方法对26例经动态心电图诊断为阵发性房颤的病人,统计房早个数、房颤的发作阵数,诱发房颤的房早联律间期、房早前周期,未诱发房颤的房早联律间期、房早前周期等。结果26例阵发性房颤患者中,24h平均房早11126±2018个,阵发性房颤248±56阵。其中22例(84.6%)由房早诱发,2例(7.68%)由短阵房速诱发,2例(7.68%)由房扑诱发。能够诱发房颤的房早联律间期及房早前周期分别为361.8±42.9ms和828±101ms,未诱发房颤的房早联律间期及房早前周期分别为426.6±43.5ms和728±107ms,诱发房颤的房早联律间期明显短于未诱发房颤的房早联律间期,呈PonT现象,诱发房颤的房早前周期比未诱发房颤的房早前周期长(p<0.01)。结论阵发性房颤主要由房早始动,其与房早的联律间期及前周期有关。     

长短周期现象与心房颤动和心房扑动

为了解心房颤动及心房扑动发生时的长短周期现象的临床意义,观察经动态心电图或监测心电图证实的心房颤动８例和心房扑动６例。结果显示：心房颤动或心房扑动发生前的长周期多见于房性期前收缩后代偿间歇及明显窦性心动过缓等心律失常;长短周期现象对心房颤动,心房扑动的启动作用可经心脏的程度刺激诱发和复制;６例患者经ＤＤＤ起搏治疗,陈发性心房颤动及心房扑动的发生率明显下降,部分病例还需服用抗心律失常药物。认为长短周     

动态心电图对阵发性心房颤动心电触发机制的分析

目的探讨阵发性心房颤动(PAf)心电触发因素及其部位,并评价其临床意义。方法对45例PAf患者的动态心电图人工回放,记录心房颤动(Af)发作次数、发作时间、发作前三个心房周期、联律间期,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45例PAf患者共248次Af发作,心电触发因素中房性期前收缩占84.97%,窦性心动过缓占7.73%,心房扑动占2.14%,房性心动过速占2.57%;房性期前收缩来源于左心房上部占69.96%,左心房下部占12.02%,右心房上部占9.87%,右心房下部占3.86%;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25ms以上;PAf发作存在23:00~1:00及9:00~11:00两个高峰,13:00~15:00一个低谷;PAf大多在短-长-短周期后发作,占62.23%,长-长-短周期后发作占21.89%。结论左心房上部房性期前收缩是PAf主要的触发因素,长-短周期现象是PAf发作的重要启动机制,自主神经失衡在PAf发作中起协同作用。动态心电图能对PAf治疗提供很大帮助。     

Initiation of ventricular fibrillation by atrial fibrillation

We report the case of a patient who developed spontaneouslya ventricular fibrillation during atrial fibrillation, 8 minafter a perfusion of isoproterenol was stopped Two mechanismscould explain the ventricular arrhythmia: silent ischaemia anda long-short cycle sequence just before ventricular fibrillation.     

Electrocardiographic antecedents of primary ventricular fibrillation. Value of the R-on-T phenomenon in myocardial infarction.

Primary ventricular fibrillation was seen in 20 of 450 consecutive patients (4-4%) admitted within 24 hours after the onset of acute myocardial infarction. Compared with patients without primary ventricular fibrillation they showed a lower mean age group and a higher incidence of anterior infarction. Warning ventricular arrhythmias preceded primary ventricular fibrillation in 58% of cases. However, warning arrhythmias were also present in 55% of patients without primary ventricular fibrillation. The following mechanisms of initiation of primary ventricular fibrillation were seen. 1) In one patient, it was initiated by supraventricular premature beats showing aberrant intraventricular conduction. 2) In 2 patients, ventricular tachycardia degenerated into primary ventricular fibrillation. 3) In 17 patients, it was initiated by a ventricular premature beat; in 10 of these, the premature beat showed early coupling (RR/QT less than 1--the R-on-T phenomenon). However, ventricular premature beats showing the R-on-T phenomenon were also observed in 49% of patients without primary ventricular fibrillation. In 7, primary ventricular fibrillation was initiated by a late-coupled ventricular premature beat (RR/QT greater than 1); in 2, the very late coupling resulted in a ventricular fusion beat. The study suggests that warning arrhythmias and the R-on-T phenomenon are poor predictors of primary ventricular fibrillation in acute myocardial infarction. The observation that 41% of primary ventricular fibrillation was initiated by a late-coupled ventricular premature beat suggests that ventricular vulnerability during acute myocardial infarction may extend throughout most of the cardiac cycle and is not necessarily confined to the QT interval.     

Sustained intra-atrial reentrant tachycardia. Electrophysiologic study of 20 cases

Twenty cases of sustained tachycardia due to intra-atrial reentry were investigated in patients aged 17 to 80 years (mean 47). The average frequency of the tachycardia was 128.6/min (extremes 95 and 180). Three modes of onset of the tachycardia were observed: atrial extra-stimulus (19 times), progressively accelerated atrial pacing (9 times) and atrial escape beat (10 times). The tachycardia was stopped in all cases by a premature stimulation. When spontaneous, the termination was either sudden (10 times) or preceded by a progressive slowing (9 times) or an alternating phenomenon of long-short cycle (13 times). Precise atrial mapping allowed to localize the first atrial depolarization less frequently in the sinus node area (1 case) than in the mean right atrium (21 cases), the low right atrium (2 cases), the interatrial septum (2 cases), and the left atrium (4 cases). The macroscopic size of the reentry circuit was demonstrated in only 3 cases. A junctional reentry was accurately ruled out in all cases thanks to the existence of a second or third-degree AV or VA black, or by studying the sequence of retrograde atrial activation. A true junctional reciprocating tachycardia was associated with the intra-atrial reentry in 2 cases.     

Electrocardiographic antecedents of primary ventricular fibrillation. Value of the R-on-T phenomenon in myocardial infarction.

Primary ventricular fibrillation was seen in 20 of 450 consecutive patients (4-4%) admitted within 24 hours after the onset of acute myocardial infarction. Compared with patients without primary ventricular fibrillation they showed a lower mean age group and a higher incidence of anterior infarction. Warning ventricular arrhythmias preceded primary ventricular fibrillation in 58% of cases. However, warning arrhythmias were also present in 55% of patients without primary ventricular fibrillation. The following mechanisms of initiation of primary ventricular fibrillation were seen. 1) In one patient, it was initiated by supraventricular premature beats showing aberrant intraventricular conduction. 2) In 2 patients, ventricular tachycardia degenerated into primary ventricular fibrillation. 3) In 17 patients, it was initiated by a ventricular premature beat; in 10 of these, the premature beat showed early coupling (RR/QT less than 1--the R-on-T phenomenon). However, ventricular premature beats showing the R-on-T phenomenon were also observed in 49% of patients without primary ventricular fibrillation. In 7, primary ventricular fibrillation was initiated by a late-coupled ventricular premature beat (RR/QT greater than 1); in 2, the very late coupling resulted in a ventricular fusion beat. The study suggests that warning arrhythmias and the R-on-T phenomenon are poor predictors of primary ventricular fibrillation in acute myocardial infarction. The observation that 41% of primary ventricular fibrillation was initiated by a late-coupled ventricular premature beat suggests that ventricular vulnerability during acute myocardial infarction may extend throughout most of the cardiac cycle and is not necessarily confined to the QT interval.     

心电散点图在心律失常快速诊断中的应用

目的通过与诊断结果对比观察,探讨心电散点图在快速诊断心律失常方面的临床应用价值。方法应用动态心电图记录仪记录患者连续24h心电信号,利用计算机自动检测技术,进行心电分析,并同步绘制24h心电散点图。将诊断结果分为窦性心律、室上性早搏、室性早搏、心房颤动、差异性传导5组,分别将4组心律失常结果与心电散点图检测的诊断结果进行对照,计算出二者的符合率及各组的B线斜率,进行分析对比。结果室上性早搏组与室性早搏、心房颤动、差传组差异显著(p<0.001);室性早搏组与室上性早搏、心房颤动、差传组差异显著(p<0.001);心房颤动组与差传组差异不显著(p>0.05)。结论心电散点图在长程大样本心电数据中,快速诊断心律失常,尤其是室上性早搏、室性早搏、心房颤动等时具有较好的临床应用价值。     

Premature atrial beat eliciting atrial fibrillation after coronary artery bypass grafting

Of patients undergoing coronary artery bypass grafting 30% develop atrial fibrillation (AF) or flutter. To determine if AF is initiated from the right or left atrium, atrial electrograms were continuously recorded in patients undergoing this procedure. In addition, to study whether the prematurity index of premature atrial contractions (PACs) eliciting AF differs from PACs not provoking AF, the distribution of prematurity indices was evaluated from R-R interval analysis. The right and left atrial recording electrodes were first activated by the ectopic beat provoking AF in six and eight patients, respectively. The prematurity index of the PAC eliciting AF was located in the middle (in half of the patients) or to the left of the median distribution of prematurity indices. The variability in activation of the atrial electrodes suggests that the PAC provoking AF can have its origin in the right, the septal, or the left region of the atrium. The initiation of AF depends on the prematurity index of the PAC.     

Relationship between beat to beat interval and left ventricular function in patients with atrial fibrillation

In atrial fibrillation, the relation between the rhythm and volume of the pulse has long been of interest. However, changes in preload in this condition have not been fully addressed since beat to beat measurement of filling volume have been difficult until recently. In the present study, we evaluated left ventricular outflow and inflow velocity using pulsed Doppler echocardiography and correlated these results with the R-R interval in the individual patient. The study population consisted of 12 patients with atrial fibrillation, aged 36 to 69 years (mean 54 years). The etiology of atrial fibrillation was idiopathic in 10 and 2 patients had dilated cardiomyopathy. Stroke and filling volume were calculated as a pruduct of the flow velocity integral of left ventricular outflow and inflow velocity, and the cross-sectional area of aortic and mitral annulus, respectively. In 10 patients with idiopathic atrial fibrillation, significant positive correlations were observed between the preceding R-R interval and both the stroke volume and the filling volume of the preceding beat when the R-R interval was shorter than 600 msec. Stroke volume and filling volume of the preceding beat were almost constant, independent of the preceding R-R interval when the preceding R-R interval was longer than 600 msec, the interval necessary for the completion of the preceding rapid filling. In the same preceding R-R interval, a larger stroke volume was observed in a shorter pre-preceding R-R interval. In 2 patients with dilated cardiomyopathy no relationship could be observed between the preceding R-R interval and the filling volume of the preceding beat or the stroke volume. In patients with a normally functioning left ventricle (idiopathic atrial fibrillation), reduced cycle length and filling volume in the preceding cardiac cycle appear to be the underlying cause of the regulation of stroke volume, dependent on Starling's law. However, in patients with dilated cardiomyopathy no significant correlation was observed between the preceding R-R interval and both the filling volume of the preceding beat and the stroke volume. In these patients the left ventricle may have limited contractile reserve and altered diastolic re-coil forces possibly due to degenerative changes of myocardium. Pulsed Doppler echocardiography provides a non-invasive method of evaluating the instantaneous changes in left ventricular flow dynamics caused by atrial fibrillation and understanding its fundamental mechanism.     

阵发性房颤、房扑的心电散点图特征

目的观察阵发性房扑、房颤的心电散点图特征,并探讨其临床意义。方法选择20例阵发性房扑、房颤患者的24小时动态心电图,回顾分析其心电散点图。结果 20例阵发性房颤、房扑患者中,17例可以通过心电散点图区分出不同心律,占总例数85%;3例无法通过心电散点图区分出不同的心律,占总例数15%。结论阵发性房扑一般可以通过心电散点图迅速鉴别,阵发性房颤绝大多数病例可以通过心电散点图迅速鉴别,心电散点图有助于提高海量心电信息中阵发性房扑房颤的分析效率。此外,心电散点图可以获得更多的生理状态下整体动态的心电信息。