24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值分析

目的分析24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值。方法选择2012年1月—2013年1月我院收治的晕厥患者80例,将其随机分为对照组和观察组,各40例。对照组采取常规心电图检查,观察组采取24小时动态心电图监测,比较两组患者严重心律失常检出情况。结果观察组严重心律失常检出率为100.0%(40/40),高于对照组的65.0%(26/40);其中阵发性心房纤颤或心房扑动、心房纤颤伴长R-R间期≥3.0s、阵发性室性心动过速、短暂心室停搏、Ⅲ度房室传导阻滞检出率均高于对照组(P0.05)。R-R间期≥3.0 s者晕厥发生率高于R-R间期3.0 s者(P0.05)。结论 24小时动态心电图监测可及时发现和明确心源性因素引起的晕厥,在临床诊断中具有重要的价值。     

动态心电图对诊断心源性晕厥的临床意义

目的 探讨心源性晕厥或猝死发作相关的心电图特征.方法 对120例疑为心源性晕厥者行24h12导联动态心电图(DCG)检查.结果 120例中55例(45.8%)出现严重心律失常,检出晕厥发作或猝死共27例;其中21例(17.5%)晕厥发作和3例(2.5%)猝死与严重心律失常有关.尤其与心室停搏(R-R间距)>3.0s及快速室性心律失常有一定的相关性.另外3例晕厥时未记录到任何心律失常.结论 12导联DCG检查可为心源性晕厥或猝死者获得可靠的病因诊断.     

不明原因性晕厥患者动态心电图的特征分析

目的探究和分析不明原因性晕厥患者动态心电图特征。方法选择我院自2017年1月至2018年1月收治的20例不明原因性晕厥患者作为研究对象,所有患者均行24小时动态心电监测,并根据患者监测期间是否出现晕厥发作将其分成晕厥组(8例)和无晕厥组(12例),对比两组患者动态心电图特征。结果监测期间,共发现13例患者存在心律失常,检出率为65.0%,其中包含6例窦性心动过缓伴窦性停博、4例窦房传导阻滞、2例三度房室传导阻滞、1例阵发性心房颤动;晕厥组患者各种缓慢性或快速性心律失常发生率、R-R间期均明显高于无晕厥组患者,两组对比差异显著,具有统计学意义(P0.05),且R-R间期3.0s者,无1例发生晕厥。结论心律失常是引发不明原因性晕厥再次发作的重要危险因素,采用动态心电图监测不仅能明确不明原因性晕厥患者的病因,还能检测其R-R间期长度,因此,其检出结果能作为指导患者临床治疗的有效依据。     

动态心电图确诊心源性晕厥五例

对5例有晕厥的患者进行动态心电图检查。结果5例晕厥发作时,动态心电图记录发现3例发生了3.0s以上的窦性停搏,2例发生了持续性室性心动过速,均确诊为缓慢性心律失常或室性快速性心律失常引起的心源性晕厥,植入了人工心脏起搏器或除颤器,防止了阿-斯综合征和猝死的发生。     

动态心电图对不明原因晕厥的诊断意义

目的 探讨动态心电图(Holter)对不明原因晕厥的诊断意义.方法 对320例不明原因的晕厥患者进行24小时动态心电图检查.结果 320例患者经动态心电图检查,116例(36.25%)出现严重心律失常,60例(18.75%)出现晕厥发作,46例(14.37%)晕厥发作与心律失常有关,尤其与R-R间期的长短有一定的相关性...     

动态心电图在不明原因晕厥诊断中的价值

目的探讨动态心电图(Holter)在不明原因晕厥诊断中的应用价值。方法对146例不明原因的晕厥患者进行24小时Holter检查。全部患者经病史、体检、常规心电图和体位性低血压试验等均未发现晕厥的直接原因。结果146例患者经Holter检查,55例(37.67%)出现心律失常,25例(17.12%)出现晕厥发作,22例(15.06%)晕厥发作与心律失常有关。尤其与心电图RR间期有一定的相关性。25例晕厥患者中,RR间期≥3.0秒者共57次,其中31次发生晕厥;而RR间期<3.0秒者256次,无1例发生晕厥(P<0.01)。结论一些不明原因晕厥的发作与心律失常有关。Holter检查对不明原因晕厥的病因诊断仍然是一种有价值的工具。     

阵发性心房颤动伴长R-R间距的临床分析

目的 了解阵发性心房颤动伴长R-R间距者心电图改变的临床意义.方法 选取动态心电图(DCG)监测出现阵发性心房颤动伴≥2.0s长R-R间距的住院者62例,对其DCG进行分析.结果 62例患者DCG监测期间心房颤动发作时出现≥2.0s心室长R-R间距(最长R-R间距3.5s)1032次,白天出现79次(7.66%)发生在13pm～15pm,夜间出现953次(92.34%)发生在22pm～5am,恢复窦律时,均无长R-R间距出现.所有患者DCG监测期间无黑矇、晕厥.结论 阵发性心房颤动伴心室长间期是否合并房室阻滞,与患者的预后、治疗密切相关,需明确诊断.     

起搏器故障致心室停搏22．08s患者1例

心源性因素是引起晕厥的主要原因。本例患者为VVI起搏器术后发生晕厥，动态心电图检查发现起搏器带动不良，同时伴心室停搏致R-R长周期最长达到22．08 s。及时更换起搏器后，患者康复出院。     

动态心电图对心房颤动伴Ⅱ°AVB的诊断价值

目的探讨动态心电图对心房颤动伴Ⅱ°房室传导阻滞(AVB)的诊断价值。方法记录198例心房颤动患者射频消融术前后的动态心电图(DCG),根据术后DCG将患者分为两组:无Ⅱ°AVB组(A组),Ⅱ°AVB组(B组),分析R-R间期2.0s、逸搏心律的分布规律及两组间的平均心率、长R-R间期及逸搏心律的平均次数。结果 198例心房颤动患者射频消融术后均成功转为窦性心律,A组中R-R间期2.0s及逸搏心律的分布与睡眠或休息明显相关,而B组中则日夜均可见;且B组中长R-R间期、逸搏心律的平均次数明显多于A组(P0.05)。结论 R-R间期2.0s超过25次/24h并出现R-R间期3.0s及心室率小于35次/分的逸搏心律,且与睡眠休息无关,或出现R-R长间期及逸搏心律时伴有头晕、黑甚至晕厥现象,需考虑心房颤动伴Ⅱ°AVB。     

心房颤动伴长R-R间期患者应用动态心电图检测的临床意义

目的探究动态心电图检测心房颤动伴长R-R间期患者的临床价值。方法本次实验对象全部选自2018年5月-2019年10月期间在本院进行诊治的60例心房颤动伴长R-R间期患者,对患者进行动态心电图检测,分析患者详情。结果60例患者中,夜间全部发生长R-R间期>1.5 s占比72.89%,白天占比27.11%,对比差异有统计学意义(P<0.05)。每分钟平均心室率在60次以下76.67%,每分钟平均心室率超过60次23.33%,对比差异有统计学意义(P<0.05)。结论动态心电图检测心房颤动伴长R-R间期患者,需重视发生时间和次数,同时与患者临床病史相结合,及早予以患者有效的干预。     

运动试验致晕厥原因分析

目的:探讨运动晕厥的原因,特点。方法:回顾性分析本组13例运动试验发生晕厥的资料。结果:4例发生晕厥时的运动量是极量,9例是亚极量,11例为血管迷走神经性晕倒,2例发生运动中,出现室性心动过速,为心源性。结论:为减少运动试验的晕厥及其严重后果,应严格掌握运动试验禁忌证,对病人宜采用亚极量运动,严密血压心电图监护,并作好急救准备。     

Prevalence of Electrocardiographic and Echocardiographic Abnormalities in Ambulatory Ischemic Colitis

The aim of this study was to evaluate the prevalence of cardiac arrhythmia and intracardiac embolic process in ambulatory ischemic colitis. From November 1994 to November 1997, 33 consecutive cases of ambulatory ischemic colitis were detected. This study included 21 women and 12 men with a mean age of 71 years. All patients underwent a cardiovascular investigation including questioning, electrocardiogram, 24-hr ambulatory electrocardiography and transthoracic echocardiography. A prior history of ischemic colitis was found in four cases (12%). Cardiac arrhythmia was detected in eight cases. Transthoracic echocardiography showed an intracardiac process, potentially responsible for a peripheral embolism, in four cases. In conclusion, the aggregate, in 33% of the patients, there was potential cardiac etiology. This suggests that when ambulatory ischemic colitis occurs, it is necessary to perform an exhaustive cardiovascular evaluation similar to those performed in other ischemic diseases.     

24-hour ambulatory electrocardiographic monitoring is unhelpful in the investigation of older persons with recurrent falls

BACKGROUND: Although frequently used in the assessment of patients with falls, it is unclear whether 24-hour ambulatory electrocardiography contributes to their assessment in older persons. OBJECTIVE: To identify electrocardiographic abnormalities in patients with recurrent falls and case controls, and determine whether 24-hour ambulatory electrocardiography identifies causal arrhythmias for falls. DESIGN: Prospective case-control study. METHODS: 24-hour ambulatory electrocardiography recordings were compared for the type and prevalence of arrhythmias and symptom correlation in consecutive older subjects with recurrent falls attending the accident and emergency department and in case controls (no previous falls or syncope). ECG abnormalities were categorised as major (ventricular arrhythmia, pauses, <30 b.p.m., Mobitz II, complete heart block) and minor (multiple ectopics, paroxysmal atrial arrhythmia and other bradyarrhythmias). RESULTS: 128 fallers (76 +/-6 years) and 100 case controls (75 +/-5 years) were recruited. Co-medication and co-morbidity were similar in both groups. 49% (63) of recordings in fallers and 41% (41) of recordings in controls were abnormal. There was no difference between groups in the prevalence of major or minor abnormalities or of symptoms during recording (breathlessness, fatigue, chest pain and dizziness). Palpitations occurred in 10% of fallers and 13% of controls. One patient fell during monitoring with no associated rhythm abnormality. CONCLUSION: Multiple abnormalities are present on 24-hour ambulatory electrocardiography in older people whether or not they have experienced falls. 24-hour electrocardiography does not discriminate between fallers and non-fallers and is not helpful in the investigation of recurrent falls.     

家族性电紊乱性心脏病未植入心律转复除颤器患者的长期随访研究

目的 研究家族性电紊乱性心脏病高危患者,未植入心律转复除颤器(ICD)的长期预后.方法 13例患者中11例长QT综合征(LQTS)、2例Brugada综合征,均有心脏性晕厥.男性4例,女性9例,平均年龄(44±19)岁.6例(46%)因心跳骤停住院治疗.4例LQTS植入起搏器,平均随访(7±4)年.结果 11例(85%)患者仍然发作晕厥,1例心脏骤停首次入院,5例(39%)心脏骤停再入院,2例LQTS死亡,其中1例(0.8%)猝死.结论 LQTS和Brugada综合征患者一旦出现晕厥,以后会反复发作,如果没有条件接受ICD治疗,其他的药物治疗、医生的密切监控随访、指导患者避免触发因素和针对家属的心肺复苏训练同样非常重要.     

变异型心绞痛诱发严重心律失常

６例变异型心绞痛（ＶＡ）患者于胸痛发作时经１２导联和（或）２４ｈ动态心电图记录到心律失常。其中心绞痛发作时伴发室性早搏二联律３例、短阵室性心动过速１例、Ⅲ度房室阻滞（ＡＶＢ）２例。１例Ⅲ度ＡＶＢ者伴有发作性晕厥。冠状动脉造影提示与缺血有关的冠状动脉狭窄３例;余３例冠脉造影结果大致正常,但麦角新碱激发试验均为阳性。２例行药物治疗,３例接受经皮冠状动脉腔内成形术治疗,１例Ⅲ度ＡＶＢ伴晕厥者置入永久性人工心脏起搏器。结果表明冠状动脉痉挛在ＶＡ患者致命性心律失常的发生中具有重要作用。     

Painless ST elevation with syncope. Diagnosis by continuous electrocardiography]

The aetiology of syncope in a 53 year old man was discovered on continuous ambulatory electrocardiography. A ventricular arrhythmia associated with ST elevation was recorded. It proved resistant to medical therapy and a double aorto-coronary bypass graft was performed. Post-operative Holter monitoring showed surgery to have been effective.     

冠心病室性心律失常患者的QT间期变异性与室性心律失常的相关分析

目的 现已明确冠心病患者发生猝死与恶性室性心律失常密切相关，本文旨在探讨冠心病患者Q-T间期变异性与发生室性心律失常的相关性。方法 采用动态心电图分析54例冠心病室性心律失常患者24hQ-T间期变异性。结果 冠心病室性心律失常患者24hQ-T间期变异性明显减低。结论 冠心病室性心律失常患者24h Q-T间期变异性较正常人明显减低，其发生心律失常的可能性将明显增加。     

Comparison of 24 hours ambulatory electrocardiography and endocavitary recording in the diagnosis of heart rate disorders]

Ninety symptomatic patients aged between 16 and 90 years were investigated by ambulatory continuous 24 hour electrocardiography. 75 of these patients underwent endocavitary exploration of atrioventricular conduction and sinus node function within 48 hour of ambulatory electrocardiography. Symptoms occurred during the recording in 30% patients, enabling the mechanism of the malaise to be determined. Every time that abnormalities in the zone surrounding the Tawara node were demonstrated by endocavitary recordings, the 24 hour electrocardiogramme showed the symptoms to be due to other causes than complete heart block. In 70% patients no symptoms were experienced but 58% of them had cardiac arrhythmias and particularly sinus node dysfunction (24 out of 37 patients) on the 24 hour electrocardiogramme. Comparing the results of these two methods of investigation, continuous electrocardiography appears to be a better technique for the diagnosis of sinus node dysfunction but endocavitary study of sinus node function would seem more suited to determine its severity. Endocavitary recordings seem more reliable in the investigation of paroxysmal atrioventricular blocks. These results demonstrate the complementary nature of these two methods in determining the causes of syncope and dizziness.     

Usefulness of prolonged QRS duration to identify high-risk ischemic cardiomyopathy patients with syncope and inducible ventricular tachycardia

We evaluated 61 consecutive patients who had coronary artery disease, decreased left ventricular function, and syncope and underwent implantation of a cardioverter-defibrillator because sustained ventricular tachycardia was inducible at electrophysiologic testing. During a follow-up of 3.0 +/- 1.8 years, 23 patients (38%) developed ventricular tachycardia. Prolonged QRS duration (>/=120 ms) was the only significant predictor of arrhythmia. The 1- and 2-year rates without ventricular arrhythmia were 82% and 77%, respectively, in patients whose QRS duration was <120 ms. In contrast, 1- and 2-year rates without ventricular arrhythmia were only 64% and 51%, respectively, in patients whose QRS duration was >/=120 ms (risk ratio 3.7, 95% confidence interval 1.4 to 9.8, p = 0.0092).     

动态心电图仪故障引起误诊断原因分析

目的 通过临床发现的动态心电图仪故障导致无心律失常患者误诊误治的病例，提出动态心电图记录器潜在的问题，提醒动态心电图医师和技师，在分析动态心电图时应注意相似结果的病例，及时发现有故障的记录器。减少因仪器故障导致的误诊误治病例。方法 两家医院2004年2月患者的动态心电图时发现4组病例的图形、结果相同。其中男6例，女4例，年龄23-68岁(平均43，3岁)。4组心律失常诊断：①阵发性心房扑动伴2：1下传，阵发性室性心动过速，室性早搏；②不纯性心房扑动伴长R—R间期；③频发性室性早搏；④二度房室阻滞，短阵室性心动过速，频发性室性早搏。结果 应用另一厂家的动态心电图仪复查，检查结果完全不同。检测动态心电图记录器后发现3组患者所佩带的闪光卡记录器存在间断供电中断导致数据写入异常。1组患者可能为软件下载路径错误导致患者本身病例未能正常调出，而误调出示教病例。结论 动态心电图仪故障可分为硬件故障和软件故障，硬件故障主要可见：①闪光卡损坏；②记录器或电池供电量不足。软件故障包括：①记录器清除数据不全；②软件下载路径发生错误等。需要及时与厂家联系。可避免故障连续发生，降低不必要的损失。提出重视并及时发现各种故障是临床和动态心电图医师与技师重要的职责。