不同剂量胺碘酮治疗心力衰竭并发快速房颤患者心室率的疗效评价

目的比较静脉应用不同剂量胺碘酮,治疗充血性心力衰竭伴快速心房颤动患者心室率的有效性及安全性。方法选取45例快速房颤患者[心室率>120bpm(次/min),心功能NYHA分级≥Ⅱ级],随机分成3个不同剂量组,每组15人。第1、2、3组每次静脉给予的负荷剂量分别为75mg、150mg和250mg,首次给予胺碘酮(生理盐水稀释成20ml)缓慢静脉注射10min,如不转复为窦性心律,以相同的剂量每30min重复一次达4次。结果三组控制房颤伴快速心室率的总有效率分别为67%、78%、91%(P>0.05)。三组心室率在用药30min后平均下降幅度分别为(6.84±7.30)bpm、(16.10±9.89)bpm、(20.37±14.55)bpm,第1组与第2、3组比较差异有统计学意义(P<0.01),用药1h后平均下降幅度分别为(14.91±11.39)bpm、(20.51±13.66)bpm、(32.36±13.59)bpm(P<0.01),用药2h后平均下降幅度分别为(31.21±22.73)bpm、(29.82±14.34)bpm、(36.95±18.29)bpm(P>0.05)。各组用药后Q-T间期、血压差异无统计学意义(P>0.05)。患者均无严重心律失常发生,未诱发或加重心功能不全。结论静脉应用不同剂量胺碘酮均能快速、安全、有效控制充血性心力衰竭并发快速心房颤动患者心室率,并能使部分患者转复。较大剂量组能够更快控制房颤患者心室率,但不良反应发生率提高。     

心房颤动的Lorenz-RR散点图分析

目的分析阵发性心房颤动(简称房颤)与持续性房颤伴不同心律失常的Lorenz-RR散点图特征,探讨Lorenz-RR散点图对房颤伴不同心律失常的诊断价值。方法对88例阵发性房颤与持续性房颤患者的24h动态心电图,回顾性分析其Lorenz-RR散点图特征。比较阵发性房颤组与持续性房颤组的平均、最快、最慢心室率及房室结功能有效不应期(AVNFRP)界线斜率。比较持续性房颤伴差传组与持续性房颤伴室性早搏(简称室早)组的平均、最快、最慢心室率及AVNFRP界线斜率。结果房颤Lorenz-RR散点图表现为扇形,当合并其他心律失常时,表现为扇形与其特征性心律失常散点图共存。阵发性房颤表现为扇形与棒球拍形图形共存。房颤伴室性早搏及房颤伴室内差异性传导有不同的散点图特征。阵发性房颤组最快心室率较持续性房颤组明显增快(P0.01)。房颤伴差传组平均心室率、最快心室率明显快于房颤伴室早组(P0.01)。结论阵发性房颤与房颤合并不同心律失常具有不同的散点图特征。Lorenz-RR散点图对鉴别房颤伴短联律间期室早与房颤伴差传具有独特的优势。     

有极慢心室率患者的心率变异与甲状腺功能

目的研究住院患者24h动态心电图中出现极慢心室率(40bpm)的心率变异指数SDNN与血甲状腺指标的关系。方法住院动态心电图检查者中,最慢心室率小于40bpm,主导节律为窦律无房颤或房扑的病例,记录性别、年龄、最慢、最快及平均心室率、最慢心室率性质、最长N-N间期及性质、心率变异指数SDNN,血甲状腺指标T3、T4、FT3、FT4、TSH,取同期住院无极慢心室率的窦律患者对照,做t检验和双变量的相关性检验。SDNN正常值为文献提供的参考值141±39ms。结果平均SDNN在有极慢心室率组男性为170.1±58.6 ms,女性为177.7±50.3 ms,无极慢心室率组男性为92.7±38.9 ms;女性为86.2±32.6 ms;平均年龄男性组与女性组无明显差异。有极慢心室率的各组均明显高于正常参考值(p0.001);无极慢心室率的窦律组明显低于正常参考值(p0.001);有极慢心室率的各组均明显高于无极慢心室率组(p0.001)。各组甲状腺指标T3、T4、FT3、FT4、TSH与年龄大多显示出了明显的相关性,与SDNN均未见明显相关性。结论在社区中老年常见病住院患者中,平均SDNN在有极慢心室率组明显高于无极慢心室率组,有极慢心室率组均明显高于正常参考值,无极慢心室率的窦律组明显低于正常参考值。各组甲状腺指标T3、T4、FT3、FT4、TSH与年龄大多显示出了明显的相关性,与SDNN均未见明显相关性。     

Lenegre病2例

<正>病历摘要例1:女性,43岁,因头晕就诊,自诉平时心率在40bpm左右,日常生活不受影响,且经常锻炼身体。于12岁时被医生发现存在二度房室阻滞。辅助检查:(1)动态心电图检查结果(见图1～3,有效记录时长23小时30分):①:窦性心律,平均心室率41bpm,最高心室率60bpm,总心搏数共50497个;平均心室     

美托洛尔并地高辛对房颤伴心力衰竭患者心室率及心功能的影响

目的：观察美托洛尔联合地高辛对永久性房颤（AF）伴心力衰竭（CHF）患者心室率及运动耐量的影响。方法：选择我院心血管内科门诊及住院AF合并CHF患者共78例,随机分为两组：地高辛组（A组）39例,地高辛联合美托洛尔组（B组）39例。入选病人常规使用利尿剂、血管紧张素转换酶抑制剂、肠溶阿斯匹林（或华法令）和地高辛治疗．待病人无液体潴留,体重恒定后．B组加美托洛尔。两组病人在药物达到治疗剂量后,再予维持剂量并观察12周。两组均于人选时及治疗第12周末记录心室率,测12导联心电图,24h动态心电图（Holter）。左室射血分数（LVEF）及6min步行试验（6MWT）．评价心功能。结果：（1）Hoher检测显示A组最小、平均心室率和B组最小、平均和最大心室率在治疗后均显著降低（P均〈0．01）,B组治疗后最大、平均心室率均较A组显著降低（P〈0．01）;（2）两组病人的LVEF和6MWT治疗后均显著增加（P〈0．01）,B组治疗后较A组显著增加（P〈0．01）。无不能耐受治疗和严重并发症发生。结论：适当剂量的美托洛尔联合地高辛能控制永久性AF伴CHF患者的心室率,显著改善其心室功能,而且安全。     

有极慢心室率患者的心率变异研究

目的观察24小时动态心电图中出现极慢心室率(40bpm)患者的心率变异指数SDNN。方法动态心电图检查者中,最慢心室率小于40bpm的病例,分为窦律无房颤或房扑组、全程房颤或房扑组(标记为"窦性"统计)、窦律伴房颤或房扑组,记录性别、年龄、最慢、最快及平均心室率、最慢心室率性质、最长N-N间期及性质、心率变异指数SDNN。另取同期无极慢心室率的窦律组90例和全程房颤或房扑组102例作对照。SDNN正常值为文献提供的参考值。结果平均SDNN在极慢心室率窦律组为200.5±57.1ms,平均年龄男性组明显低于女性组(p0.05);极慢心室率房颤或房扑组为232.2±39.6ms,平均年龄男性组明显低于女性组(p0.001);无极慢心室率窦律组为103.0±39.7ms,平均年龄男性组与女性组无明显差异;无极慢心室率房颤或房扑组为151.8±42.5ms,平均年龄男性组明显低于女性组(p0.05)。有极慢心室率的各组均明显高于正常参考值(p0.001~0.05);无极慢心室率的窦律组明显低于正常参考值(p0.001);无极慢心室率的房颤或房扑组的全组和男性组明显高于正常参考值(p0.05)。结论常见病患者中,平均SDNN在有极慢心室率各组均明显高于无极慢心室率的各组,男性出现极慢心室率的平均年龄明显早于女性;有极慢心室率的各组和无极慢心室率的房颤或房扑组的全组和男性组均明显高于正常参考值,无极慢心室率的窦律组明显低于正常参考值。     

动态心电图对心房颤动伴长R-R间距的心室率的分析

目的探讨心房颤动伴长R-R间距的24小时心室率变化情况。方法回顾性分析60例住院者动态心电图（DCG）检查结果,对心房颤动伴长R-R间距32例（A组）;窦性心律,偶发房性期前收缩及室性期前收缩28例（B组）。观察两组长间歇出现的规律。采用最高、最低、平均心室率、24h总心室率、每小时平均心率等参数分析心房颤动伴长R-R间距的心室率波动情况。结果大于2s以上长R-R间距90%上出现在晚上（22：00-6：00）。A组最高心室率、平均心室率、24h总心搏数均快于B组,有显著性差异（P〈0.05,P〈0.001）。A组最低心室率低于B组,有显著性差异（P〈0.001）。结论心房颤动者睡眠时出现长R-R间距是常见现象,不应因为DCG发现长间歇而忽视了对心房颤动心室率的控制。     

心房颤动患者临床症状与动态心电变化的关系探讨

探讨心房颤动 (AF)患者临床症状与动态心电变化的关系。记录 6 7例AF病人的 2 4h心电图 ,并记录临床症状及发生时间 ,比较症状发生时动态心电的变化特征。结果 :①持续性AF与阵发性AF相比、夜晚与白天相比、使用与未使用抗心律失常药物相比 ,其病人的平均心室率显著较慢 ,发生长间歇的频次显著较高 ,而不同病因的AF患者之间相比 ,特发性AF其发生长间歇例数及频次均少于其他原因的AF ;②窦性心律转为AF、心室率过快 ( >10 0次 /分 )或过慢 ( <5 0次 /分 )、长间歇 >3s、长间歇连续 3次以上发生均可能导致临床症状的发生 ,其中以心悸、呼吸困难最为常见 ,头晕、黑较少见 ,晕厥最少见。结论 :AF患者的临床症状与AF类型以及一些特征性的动态心电变化有关。     

RR间期与持续性心房颤动左室收缩功能的相关性

目的:探讨RR间期与持续性心房颤动左室收缩功能的相关性。方法:回顾性分析2018年1月—2020年1月42例行超声心动图检查的持续性心房颤动病人的临床资料,分析心房颤动发生时绝对不齐心室率与血流动力学指标关系,同时评估RR1/RR2为0.91～1.10。单次心搏与多心动周期平均值测量相关性及一致性。结果:左室射血分数(LVEF)、每搏输出量(SV)与RR1和RR1/RR2均呈正相关(P<0.05);其中心率标准差≥30次/min, SV与RR1/RR2相关性更强(P<0.05);以病人全部心动周期测量LVEF和SV平均值作为标准,每例病人RR1/RR2为0.91～1.10单次心搏测量获得LVEF和SV与标准测量方法具有良好相关性(r值分别为0.88,0.92,P均<0.01)。一致性分析结果显示,RR1/RR2=0.91～1.10单次心搏和全部心动周期测量LVEF和SV平均值差值均位于95%置信区间(CI)范围内,具有良好测量一致性。结论:持续性心房颤动左室收缩功能与心率水平和规整程度有关;RR1/RR2为0.91～1.10单次心搏可用于评估病人左室收缩功能。     

老年心力衰竭合并心房颤动病人血清NT-proBNP的临床意义

目的分析老年心力衰竭合并心房颤动病人血清氨基末端脑钠肽前体(NT-proBNP)特点,探讨心房颤动、心脏结构、心功能分级、心室率与NT-proBNP水平变化的关系。方法回顾性分析我院住院治疗的100例老年心力衰竭病人,合并心房颤动者49例(AF组),无心房颤动者51例(SR组)。两组病人入院时抽血,检测血清NT-proBNP水平,行超声心动图检查。结果 AF组与SR组左房内径(LAD)、左室舒张末内径(LVEDd)、左室射血分数(LVEF)比较,差异有统计学意义(P0.01);AF组NT-proBNP显著高于SR组(P0.05)。两组NT-proBNP随心功能分级增加而升高(P0.01);心力衰竭合并快速心室率心房颤动,其NT-proBNP明显升高(P0.05或P0.01)。结论老年心力衰竭合并心房颤动NT-proBNP明显升高;心房颤动病人左房明显增大;心房颤动、心功能分级、心室率均是影响NT-proBNP水平的因素。     

The assessment of autonomic function in chronic atrial fibrillation: description of a non-invasive technique based on circadian rhythm of atrioventricular nodal functional refractory periods.

AIMS: Heart rate variability (HRV) parameters can be used to assess autonomic function and to predict outcome, but this has been done exclusively in patients with sinus rhythm. Atrial fibrillation (AF) is the commonest sustained arrhythmia and is particularly prevalent in heart failure. We have developed a simple index to assess autonomic function in patients with chronic AF. METHODS AND RESULTS: Forty patients with chronic AF (>1 month) and symptoms of heart failure underwent ambulatory 24 h electrocardiography recording as well as evaluation of symptoms, exercise capacity (6 min walk distance), ventricular function (echocardiography and radionuclide ventriculography), and neuroendocrine activation. A number of standard HRV parameters shown to have prognostic significance in sinus rhythm were also determined. A modified in-house HRV statistical programme was used to filter labelled QRS intervals and to compute the 5th percentile RR interval in each hour. This parameter has been shown to approximate the functional refractory period (FRP) of the atrioventricular node (AVN). A cosine curve was fitted to hourly 5th percentile RR intervals for each patient and from this was estimated the diurnal change in hourly 5th percentile RR interval (approximating DeltaFRP of the AVN) and, by inference, diurnal variation in sympathovagal input to the AVN. Digoxin was the sole agent permitted for control of ventricular rate. DeltaFRP of the AVN varied and revealed a significant correlation, on multivariate analysis, with mean RR interval (P<0.001), SDARR (SD of 5-min average RR intervals during 24 h, P<0.001), and NYHA class of heart failure (classes III and IV heart failure vs. classes I and II, P=0.02). SDARR has previously been shown independently to predict mortality in patients with chronic AF and heart failure. CONCLUSION: This analysis describes a novel non-invasive method for assessing autonomic function in chronic AF. Whether DeltaFRP in chronic AF patients can independently predict adverse prognosis or sudden death requires further study.     

Physiological limits of variations in heart rate measured by the Holter method in 134 normal subjects

Ambulatory 24 hour electrocardiography by the Holter method was carried out in 134 normal subjects (59 men, 75 women, mean age: 42.5 +/- 14 years). The average heart rate over 24 hours was 75 +/- 9 bpm, 82 +/- 10 bpm during the daytime and 64 +/- 8 bpm at night. Maximal and minimal momentary variations (over 5 minutes) were small during the night (+23% and -7%) and greater during the daytime (+47% and -16%). The heart rate slowed progressively over a two hour period before going to bed an increased progressively over a three hour period, reaching a peak and then slightly falling before getting up. The average heart rates of women were faster than in men (+5 bpm). The average heart rate fell with age from 30 years onwards (-0.4 bpm per year). Tobacco consumption did not seem to affect the heart rate. Supraventricular extrasystoles were observed in 68% of subjects during the day, and in 50% during the night; ventricular extrasystoles occurred in 42% of subjects by day and in 23% by night. Only 22% of subjects had no extrasystolic activity. Tobacco consumption and sex were unrelated to the incidence and frequency of extrasystoles. On the other hand, the incidence and frequency of extrasystoles were very significantly related to age.     

心室率控制满意的慢性心房颤动患者的动态心电图表现

目的评价心室率控制满意的持续性心房颤动(房颤)患者的24小时动态心电图(Holter)表现。 方法选择心室率控制满意的122例伴有器质性心脏病的持续性房颤患者。心功能(NYHA)分级Ⅱ～Ⅲ级。回顾性分析其Holter，观察心室率及长RR间期的动态表现，并对部分患者进行随访。 结果Holter检查结果示日平均心室率为78.53±8.12(65～90)次/分。平均最快心率143.79±28.85(90～183)次/分，平均最慢心率51.04±7.52(34～71)次/分。62/122例(50.82%)出现＜50次/分的心动过缓。32/122例(26.23%)出现＜45次/分的心动过缓。95/122例(77.87%)出现＞1.5秒的长RR间期，平均最长RR间期为2.38±0.55(4.64～1.60)秒。14/122例(11.48%)出现＞3.0秒的长RR间期。随访结果表明，长RR间期未见进一步加重。 结论心室率控制满意的房颤患者，休息及睡眠时出现长RR间期及心动过缓是常见现象。     

Atrial premature complexes and heart rate have prognostic significance in 1-month atrial fibrillation recurrence after electrical cardioversion.

AIMS: The aim of this study was to investigate the significance of simple 24-h Holter (24H) data after electrical cardioversion (CV) for atrial fibrillation (AF) recurrence. METHODS: We prospectively studied 47 consecutive patients subjected to CV, who successfully converted to sinus rhythm. All underwent echocardiography and 24H after CV. AF recurrence was studied at 14 days and 1 month by second 24H or by interim report of AF. RESULTS: About 53.2% remained in sinus rhythm (group I) and the rest recurred to AF (group II). Group I had fewer atrial premature complexes per hour (APC/h) (P = 0.002) and lower maximum (max HR), average, and minimum heart rates compared with group II (all Ps < 0.05). The optimal value of APC/h and max HR with best sensitivity and specificity was 32 APC/h and 90 bpm, respectively. These findings were the predictors of AF recurrence [hazard ratio (HR) = 4.5 with 95% CI = 1.7-11.7 and HR = 4.3 with 95% CI = 1.7-10.9, respectively]. Patients with the combination of both predictors had greater HR of AF recurrence compared with those with < 32 APC/h and max HR < 90 bpm (HR = 8.8 with 95% CI = 2.5-31.4). CONCLUSION: Patients with frequent APC/h and high max HR are at high risk for 1-month AF recurrence after electrical CV.     

Anti-arrhythmic effect of amiodarone in the 24 hours following a single oral loading dose. Clinical and pharmacological study

This study demonstrated the rapid antiarrhythmic effects of oral amiodarone (Am). A single 30 mg/kg dose was given to 67 patients, 18 with supraventricular arrhythmias (atrial extrasystoles: 11 cases, reciprocating tachycardia: 4 cases, intraatrial reentrant tachycardia: 2 cases, paroxysmal atrial fibrillation, AF: 1 case). Eighteen patients had permanent AF. Thirty-one patients had ventricular arrhythmias (ventricular extrasystoles, VES, isolated or in salvos: 22 cases, and ventricular tachycardia, VT: 19 cases). The effect on atrial extrasystoles was significant 4 to 13 hours after AM and maximal (-98% +/- 3.6%) at 7.7 +/- 1 hours. They recurred in 3 cases at the 18th hour. No significant effects were observed on the other supraventricular tachycardias. The effect on the atrioventricular node (AVN) assessed by the ventricular response to permanent AF, was significant after the 3rd hour and maximal ( = 38 +/- 6 bpm) at the 7th hour. The reduction in the frequency of VES was significant from the 5th to the 19th hour of treatment. Control of VT was obtained in 5 cases between the 3rd and 8th hours. The treatment was well tolerated as no side effects were reported. The plasma concentration (PC) of amiodarone (54 patients) and of N-desethylamiodarone (NDA) (36 patients) were measured; the maximal values were 2.53 +/- 1.5 mg/l for Am and 0.22 +/- 0.1 mg/l for NDA. A 60% decrease in the number of VES was observed with PC of Am of 1.90 +/- 0.3 mg/l and a 20% reduction in the ventricular response to AF at PC of Am of 1.50 +/- 0.33 mg/l.(ABSTRACT TRUNCATED AT 250 WORDS)     

动态血压监测探讨体重指数与血压的关系

目的:动态血压监测探讨患者体重指数与血压变化情况。方法:选择门诊和病房住院的患者共691例(其中男性417例,女性274例),年龄范围13~90岁,平均年龄为55岁。所有观察对象测量诊室血压、心率、身高、体重和监测24小时动态血压等指标,按照体重指数分为3组,体重指数<24为正常体重组;24≤体重指数<28为超重组;体重指数≥28为肥胖组。结果:肥胖组患者24小时和白天的平均收缩压/舒张压、夜间平均舒张压以及24小时、白天和夜间心率均高于正常体重组,有显著性差异(P<0.05~0.01)。此外,血压负荷也随着体重指数的增加而增加,有显著性差异(P<0.05~0.01)。结论:体重指数与动态血压和血压负荷有较密切的关系;与正常体重组、超重组比较,肥胖组患者的血压最高、心率最快;动态血压提供的数据信息量大,结论更可靠、准确。     

Effect of diurnal variability of heart rate on development of arrhythmia in patients with chronic obstructive pulmonary disease

We examined the possible effect of diurnal variability of heart rate on the development of arrhythmias in patients with chronic obstructive pulmonary disease (COPD). Forty-one COPD patients (M/F: 39/2, mean age: 59+/-8.5 years) and 32 (M/F: 27/5, mean age: 57+/-11 years) healthy controls were included. Twenty-four hour ECG recordings were analyzed for atrial fibrillation (AF) or ventricular premature beats (VPB), and circadian changes in heart rate variability (HRV) were assessed by dividing the 24-h period into day-time (08:00-24:00 h) and night-time (24:00-08:00 h) periods. Night-time total (TP), low frequency (LF) and high frequency (HF) powers were similarly lower from day-time parameters in AF(-) COPD patients (HF 3.91+/-1 vs. 4.43+/-1.04 ms(2), P=0.001) and controls (HF 3.95+/-0.72 vs. 4.82+/-0.66 ms(2), P<0.001). The LF/HF ratios were also significantly reduced in the same patient groups (AF(-) COPD 1.35+/-0.21 vs. 1.27+/-0.19, P=0.04, controls 1.43+/-0.14 vs. 1.24+/-0.09, P<0.001). Night-time TP and LF were increased, HF unchanged and LF/HF significantly increased (1.11+/-0.25 vs. 1.19+/-0.27, P<0.05) in AF(+) COPD patients. Frequency of VPB was correlated with corrected QT dispersion (QTc(d)) (r=0.52, P=0.001) and the day-time/night-time HF ratio (r=0.43, P=0.02). Patients with QTc(d)>or=60 ms did not have the expected increase in night-time HF and had a statistically insignificant increase in LF/HF ratio. In COPD patients with QTc(d)<60 ms, circadian changes in HRV parameters were parallel with the controls. We concluded that COPD patients with arrhythmia had circadian HRV disturbances such as unchanged night-time parasympathetic tone and disturbed sympatho-vagal balance in favor of the sympathetic system all day long, which may explain the increased frequency of arrhythmia.     

Is beta‐blockade useful in heart failure patients with atrial fibrillation? An analysis of data from two previously completed prospective trials

BACKGROUND: Beta-adrenergic blockade is of proven value in chronic heart failure. It is uncertain, however, if beta-blockade provides a similar degree of clinical benefit for heart failure patients with atrial fibrillation (AF) as those in sinus rhythm (SR). AIMS: To compare the effectiveness of beta blockade in patients with heart failure and AF. METHODS: Patients with chronic heart failure were randomized to treatment (double blind) with metoprolol 50 mg twice daily or carvedilol 25 mg twice daily in addition to standard therapy. Response was assessed after 12 weeks by a quality of life questionnaire, New York Heart Association class, exercise capacity (6-min walk test), radionucleotide ventriculography for LVEF, 2-D echocardiography measurement of left ventricular (LV) dimensions and diastolic filling and 24-h electrocardiograph monitoring to assess heart rate changes. RESULTS: Both beta-blockers produced significant improvements in LVEF in both the SR group: (+6+/-10% at 12-week, P<0.001) and the AF group: (+11+/-9% at 12-week, P<0.05). However, significant improvement in symptoms (P<0.001) and exercise capacity (P<0.001) were observed only in the SR group but not in the AF group despite a significant improvement in LVEF. CONCLUSION: Beta-blockers were effective in improving LV ejection fraction in chronic heart failure patients in either SR or AF but had less effect on symptoms and exercise capacity in those with AF.     

Therapeutic Effects of Selective Atrioventricular Node Vagal Stimulation in Atrial Fibrillation and Heart Failure

Therapeutic Effects of Selective AVN‐VS in AF and HF. Introduction: Atrial fibrillation (AF) and heart failure (HF) frequently coexist. We have previously demonstrated that selective atrioventricular node (AVN) vagal stimulation (AVN‐VS) can be used to control ventricular rate during AF. Due to withdrawal of vagal activity in HF, the therapeutic effects of AVN‐VS may be compromised in the combined condition of AF and HF. Accordingly, this study was designed to evaluate the therapeutic effects of AVN‐VS to control ventricular rate in AF and HF. Methods and Results: A combined model of AF and HF was created by implanting a dual chamber pacemaker in 24 dogs. A newly designed bipolar electrode was inserted into the ganglionic AVN fat pad and connected to a nerve stimulator for delivering AVN‐VS. In all dogs, HF was induced by high rate ventricular pacing at 220 bpm for 4 weeks. AF was then induced and maintained by rapid atrial pacing at 600 bpm after discontinuation of ventricular pacing. These HF + AF dogs were randomized into control (n = 9) and AVN‐VS (n = 15) groups. In the latter group, vagal stimulation (310 μs, 20 Hz, 3–7 mA) was delivered continuously for 6 months. Compared with the control, AVN‐VS had a consistent effect on ventricular rate slowing (by >50 bpm, all P < 0.001) during the entire 6‐month observation period that was associated with left ventricular functional improvement. Moreover, AVN‐VS was well tolerated by the treated animals. Conclusions: AVN‐VS achieved consistent rate slowing, which was associated with improved ventricular function in a canine AF and HF model. Thus, AVN‐VS may be a novel, effective therapeutic option in the combined condition of AF and HF. (J Cardiovasc Electrophysiol, Vol. 24, pp. 86‐91, January 2013)     

慢性心房颤动对扩张性心肌病患者长期预后的影响

探讨慢性心房颤动 (简称房颤 )对扩张性心肌病患者长期预后的影响。将扩张性心肌病并心力衰竭 (简称心衰 )患者分为窦性心律 (简称窦律 )组 (共 38例 ,其中男 2 5例、女 1 3例 )和房颤组 (共 37例 ,其中男 2 5例、女 1 2例 ) ,二组基础状态基本相似。房颤组只控制心室率。随访二组患者的临床预后情况 ,包括 :死亡人数 ,死亡原因 ,入选至死亡的生存时间。结果 :经过 4 8.3± 2 5 .0月随访 ,发现二组患者远期生存率相似 ,死亡患者生存时间相似 ,死亡方式相似 ;与窦律组相比 ,房颤组左房内径较大 (5 3.1± 5 .6mmvs4 7.1± 4 .8mm)、最快心室率较快 (1 6 2 .8± 1 9.3vs1 1 7.2± 1 6 .9) ,二组差异有显著性 (P <0 .0 5 )。结论 :慢性房颤对扩张性心肌病的远期预后可能无明显影响