快慢综合征2例

预激综合征病人偶有猝死发生,过去多认为预激旁道不应期短,对心室缺乏保护,使快速的室上性激动传到心室,引起室颤而死亡。本文报告２例预激综合征患者发生心动过速后常伴有阿斯综合征的发生,结合其临床及心电图特点,探讨其发生晕厥的原因。临床资料　本组２例,男女各１例,年龄分别为４６岁和４０岁,体表心电图均诊断为Ａ型预激综合征。有阵发性心动过速史,发作时心率均高于２００／ｍｉｎ,伴有明显的ＳＴ段下移,心动过速终止后常伴有晕厥或阿斯综合征,心电图或动态心电图检查示心率缓慢,明显ＳＴ段下移,心动过速终止几分钟后…     

心脏性猝死一例

患者男性 ,5 7岁。于 2 0 0 2年 4月 6日上午佩戴动态心电图记录器 ,19:5 5在家猝死。死后用美国博利屋 880 0Ⅱ型动态心电图机回放全过程 ,显示出患者自心律失常至死亡全过程的心电图记录。 10 :5 5 (图 1A)为心房颤动 (房颤 ) ,心室率平均为 70次 min。 19:4 0 (图 1B)为房颤伴快速心室率 (2 14次 min) ,19:4 0 :0 8(图 1C)出现室性早搏诱发心室颤动 (室颤 )。 19:4 9:5 8出现粗大室颤波 (图 1D) ,持续 1min后出现心室电机械分离致心脏完全停搏 (图 1E、F、G)。讨论　室颤是大多数心脏性猝死的直接原因已得到公认 ,但心脏性猝死的室颤…     

心房颤动伴长R-R间距的临床意义

目的 探讨房颤伴长R—R间距的临床意义。方法 对动态心电图（13（3G）记录到的19例房颤伴长R—R间距者进行相关分析,对19倒分成平均心室率〈60次／min及≥60次／min,长R—R间距〈2．5s厦≥2．5s．长R—R间距与睡眠相关及与睡眠不相关进行比较。结果 19例中长R--R间距238次,白天32次（17．7％）、夜间206次（82．3％）;平均心室率〈60次／rain13倒、≥60次／rain6例;长R—R间距〈2．5s7例、≥2．5s12例;长R—R间距与睡眠相关11倒、不相关8例。19倒中6例有头晕、黑礞或晕厥病史．其平均心室率〈60次／rain,最长的R—R间距均≥2．5s,且与睡眠不相关。结论 房颤伴长R—R间距多出现于夜间睡眠时,其平均心室率越慢R-R间距越长．与睡眠不相关时易发生头晕或晕厥．多为病理性房室阻滞。     

肥厚型心肌病伴心房颤动患者临床特点分析

目的分析32例肥厚型心肌病伴心房颤动患者的临床特点。方法选择1994-2005年在解放军总医院心脏中心就诊的肥厚型心肌病患者158例，平均随访（4．2±2．8）年，按病史、心电图、动态心电图是否记录到心房颤动分为房颤组和非房颤组，观察并比较2组患者的临床特点。结果（1）肥厚型心肌病伴房颤患者共32例，占全部肥厚型心肌病患者的20．3％，其中阵发性房颤14例（43．7％），持续性房颤18例（57．3％），无症状性房颤5例（15．6％）；（2）与非房颤组患者比较，房颤组患者平均年龄偏大（58±10．4vs46±12．6）岁（P〈0．01），左房直径大（42±3．5vs34±5．3）mm（P〈0．01）；（3）房颤组12例（心力衰竭8例，猝死4例）发生心血管事件，非房颤组9例（心力衰竭6例，猝死3例）发生心血管事件。房颤组患者中，房颤引发室颤1例（3％），脑栓塞2例（6．3％），下肢动脉栓塞2例（6．3％）。结论（1）20．3％肥厚型心肌病患者伴心房颤动，其中43．7％为阵发性房颤，57．3％为持续性房颤，15．6％为无症状性房颤；（2）与肥厚型心肌病不伴房颤患者相比，伴房颤患者年龄偏大，心血管事件发生率高。     

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。     

心室电风暴19例回顾性分析

目的 探讨心室电风暴的临床特征及心电图特点.方法 回顾性分析19例心室电风暴患者的临床资料.结果 19例心室电风暴患者均出现一项或多项心电图异常改变,主要表现为室速/室颤,但在室速/室颤发作前常有交感神经激活,伴有相应的一些预警性心电图表现.结论 早期识别心室电风暴的临床特征及心电图特点,及时采取有效的抢救措施,是治疗...     

心房颤动伴心室长间歇的临床意义

目的 了解心房颤动伴心室长间歇的发生机制和临床意义.方法 对动态心电图记录到的86例心房颤动伴心室长间歇的患者进行分析,男性52例,女性34例,年龄25～85(54±8)岁.其中持续性房颤48例、阵发性房颤38例.结果 86例患者中房颤伴心室长间歇≥1.5 s的有(267.4±56.2)次,最长为2.1～4.0 s,其中60例心室长间歇发生在凌晨1-4时,26例昼夜均有发作且12例有晕厥发作.10例电复律转为窦性心率后,3例存在房室阻滞,其中Ⅰ度房室阻滞1例、Ⅱ度房室阻滞2例.结论 心房颤动伴心室长间歇多发生在凌晨睡眠时,如能及早做出房颤伴Ⅱ度房室阻滞诊断有重要的临床意义.其发生机制可能与房室传导障碍、隐匿性房室传导、迷走神经张力增高、间歇性房室结不应期延长或隐匿性交界性早搏有关.     

心房颤动伴其他心电异常的诊断

心房颤动（房颤）是临床最常见的持续性快速心律失常。其危害不仅是快速不规整的心室率可引起临床症状、影响心功能；同时房颤增加血栓栓塞的危险（房颤患者卒中的发生率增加5倍），显著增加致残和致死率；房颤并房室阻滞、窦房结功能不全和预激综合征等又可引起晕厥和猝死。随着动态心电图和导管消融的临床应用对这些与心源性晕厥和猝死有关的临床心电图诊断已成为临床和心电图医师关注的新热点。     

Wolff-Parkinson-White(W-P-W)综合征术后长期随访

平均年龄31(2～59)岁的45(男28,女17)例W-P-W患者,均有快速心律失常史.临床特点为:心悸45例,晕厥17例,心脏骤停3例.心电图表现有:窄QRS波32例,宽QRS波21例,(心)房颤(动)或(心)房扑(动)12例,(心)室颤(动)2例.包括冠心病2例,二尖瓣病变3例,Ebstein畸形3例,房间隔缺损1例.手术指征为:多种抗心律失常药物无效或有毒性反应20例,室颤3例,快心室率的自发性房颤伴预激QRS波(最短RR间期为212±51ms)7例,宁愿手术11例,其它心脏手术指征4例.     

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。     

Atrial fibrillation

The prevalence and incidence of atrial fibrillation increase with age. Atrial fibrillation is associated with a higher incidence of coronary events, stroke, and mortality than sinus rhythm. A fast ventricular rate associated with atrial fibrillation may cause tachycardia-related cardiomyopathy. Management of atrial fibrillation includes treatment of underlying causes and precipitating factors. Immediate direct-current cardioversion should be performed in persons with atrial fibrillation associated with acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta-blockers, verapamil, or diltiazem may be used to immediately slow a fast ventricular rate associated with atrial fibrillation. An oral beta-blocker, verapamil, or diltiazem should be given to persons with atrial fibrillation if a rapid ventricular rate occurs a rest or during exercise despite digoxin. Amiodarone may be used in selected persons with symptomatic life-threatening atrial fibrillation refractory to other drug therapy. Nondrug therapies should be performed in persons with symptomatic atrial fibrillation in whom a rapid ventricular rate cannot be slowed by drug therapy. Paroxysmal atrial fibrillation associated with the tachycardia-bradycardia syndrome should be managed with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in persons with atrial fibrillation in whom symptoms such as dizziness or syncope associated with non-drug-induced ventricular pauses longer than 3 seconds develop. Elective direct-current cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than medical cardioversion in converting atrial fibrillation to sinus rhythm. Unless transesophageal echocardiography shows no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective direct-current or drug cardioversion of atrial fibrillation and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer the treatment strategy of ventricular rate control plus warfarin rather than to maintain sinus rhythm with antiarrhythmic drugs, especially in older patients. Digoxin should not be used in persons with paroxysmal atrial fibrillation. Patients with chronic or paroxysmal atrial fibrillation who are at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio (INR) of 2.0 to 3.0. Persons with atrial fibrillation who are at low risk for stroke or who have contraindications to warfarin should receive 325 mg aspirin daily.     

Short QT interval syndrome: a case report

Twelve-lead electrocardiograms revealed fine atrial fibrillation and a short QT interval (SQTI) (<300 milliseconds) with an average ventricular rate of 54/min in a 20-year-old male presented with exertional dyspnea. His echocardiographic evaluation revealed interatrial septal aneurysm and slightly dilated pulmonary artery. An electrophysiologic study revealed atrial fibrillation with a very high frequency, short ventricular effective refractory period (130 milliseconds) and ventricular fibrillation inducible with 3 short coupled extrastimuli. Signs were consistent with the rare SQTI syndrome. Although SQTI syndrome is associated with increased risk for sudden cardiac death, the patient was free of arrhythmia symptoms and denied any syncope or presyncope. Family history was also negative for sudden cardiac death and for any symptom suggestive of arrhythmia. The patient refused implantable defibrillator and was treated with anticoagulation and quinidine therapy.     

Changes in left atrial size in patients with lone atrial fibrillation

A retrospective analysis was performed on 23 subjects with lone atrial fibrillation who were followed for an average of 6.2 years (1.1-12.8 years). In all patients, underlying organic heart disease was excluded based on history, physical exam, electrocardiogram, echocardiogram, and Doppler ultrasound interrogation. All patients had at least two echocardiographic studies during the period of observation. Atrial fibrillation was chronic in 11 subjects and paroxysmal in 12. All echocardiographic measurements were obtained by averaging the measurements of two blinded investigators. Left atrial size increased an average of 5.6 mm which translates into a 14.7% increase over the baseline measurement. This increase in size was not associated with a change in left ventricular mass or fractional shortening as determined by echocardiography. Subjects with chronic atrial fibrillation had a larger percent increase than subjects with paroxysmal atrial fibrillation (18.9 vs. 10.8%), although this relative change in size failed to reach statistical significance. The only variable which significantly contributed to the change in left atrial size was the duration of follow-up. We conclude that atrial fibrillation occurring in patients with lone atrial fibrillation may cause a slow and progressive increase in left atrial size independent of changes in left ventricular size or function.     

Silent Atrial Fibrillation and Cryptogenic Strokes

A new suspected cause of cryptic strokes is “silent atrial fibrillation.” Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients with a recent stroke found that 7.7% had new atrial fibrillation on their admitting electrocardiogram. In 3 weeks during and after hospitalization, another 16.9% were diagnosed. A total of 23.7% of these stroke patients had silent atrial fibrillation; that is, atrial fibrillation diagnosed after hospital admission. Silent atrial fibrillation is also frequent in patients with pacemakers who do not have a recent stroke. In a pooled analysis of 3 studies involving more than 10,000 patients monitored for 24 months, 43% had at least 1 day with atrial fibrillation lasting more than 5 minutes. Ten percent had atrial fibrillation lasting at least 12 hours. Despite the frequency of silent atrial fibrillation in these patients with multiple risk factors for stroke, the annual incidence of stroke was only 0.23%. When silent atrial fibrillation is detected in patients with recent cryptogenic stroke, anticoagulation is indicated. In patients without stroke, silent atrial fibrillation should lead to further monitoring for clinical atrial fibrillation rather than immediate anticoagulation, as some have advocated.     

非瓣膜性心房颤动患者的卒中危险因素分析

卒中是非瓣膜性心房颤动(以下简称为房颤)的主要并发症。心力衰竭、高龄、高血压、糖尿病及卒中或短暂性脑缺血发作史与房颤患者卒中的风险相关,此外,临床上其他原因所致的缺血性卒中的危险因素也与房颤患者的卒中风险相关。筛选房颤患者并发卒中的危险因素,并采取有效方法评估其卒中的危险性,无论是对于抗凝治疗预防卒中事件,还是对于减少抗凝治疗引起的出血风险,都具有十分重要的意义。     

心房颤动患者“曲尺”状Lorenz散点图的临床意义

目的：分析心房颤动（房颤）患者Lorenz散点图的特点,并探讨“曲尺”状Lorenz散点图的临床意义。方法从2012年1月至2013年7月于武汉大学人民医院确诊的房颤患者中,按照一定的标准选取220例,行体表心电图、24 h动态心电图、超声心动图检查,检测长RR间期个数、24 h平均心率、各心腔内径、左心室射血分数（ LVEF）等指标。结果 Lorenz散点图“曲尺”状图形表现为散点图的扇形圆边缘被一“曲尺”状图形覆盖,边界清晰。根据有无“曲尺”状图形,将入选的220例病例分为A组（n=40）、B组（n=180）。两组病例中RR间期〈1．5 s个数、最慢心率、最快心率、24 h平均心率、左右心房及右心室内径、左心室射血分数均差异有统计学意义（P〈0．05）;年龄、RR间期〈2．0 s个数、主动脉内径、左心室内径、室间隔及左心室后壁厚度差异无统计学意义（ P〉0．05）。结论房颤患者Lorenz散点图中“曲尺”状图形与平均心率下降、左心房内径增大、LVEF减低相关,提示心房存在明显结构重构和电重构。     

预激综合征合并心房纤颤心电图分析

目的 分析探讨预激综合征合并心房纤颤的心电图特征及鉴别诊断。方法 分析11例预激综合征合并心房纤颤的心电图的心室率、 f波、RR间距的变化范围以及QRS波的表现。结果 11例心室率为160－230次／分,平均180次／分;当心室率＞180次／分时,全部导联见不到f波;RR间距的变化范围为0．18－0．76s;QRS波绝大多数表现为完全预激图形,少数为典型预激图形及正常QRS图形。结论 预激综合征合并心房纤颤的心电图特征是：极快速的心室率,RR间距绝对不等,QRS波增宽呈delta波,QRS波表现为完全预激图形、典型预激图形及正常QRS的不同组合。     

以动态心电图心室率参数指导心房颤动伴长R-R间距者活动时心室率的控制

目的探讨心房颤动(Af)伴长R-R间距活动时的心室率控制情况。方法回顾分析92例住院者的动态心电图(DCG)检查结果,其中:①Af伴长R-R间距62例(A组);②窦性心律、偶发房性早搏及室性早搏30例(B组)。观察两组的心室率分布情况。将A组患者在强心、利尿、抗凝的药物治疗基础上随机分为:常规组(A1组)30例,倍他乐克25毫克2/日;非常规组(A2组)32例,倍他乐克50毫克1/日。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Af伴长R-R间距的心室率控制情况。结果 A组最高心率、平均心率、24h总心率均快于B组,差别有统计学意义(P<0.05,P<0.001)。A组最低心率慢于B组最低心率,差别有统计学意义(P<0.001)。通过适当增加晨起给药量倍他乐克50毫克1/日能达到更好的运动时心室率的控制。患者的最高心率、平均心率、24h总心率均慢于A1组,差别有统计学意义(P<0.05,P<0.001)。其最低心率与B组差别无统计学意义(P>0.05)。结论采用24h DCG对心室率等各项参数进行观察,为临床治疗和疗效的判断提供依据。提示在心室率高峰前用药,即合理增加晨起给药量,可达...     

Amiodarone in Atrial Fibrillation

ABSTRACT Twenty-seven patients with atrial fibrillation without any concomitant conduction abnormality have been treated with oral amiodarone in a daily maintenance dose of 200 mg. The drug has been used for three purposes: 1) to block atrioventricular conduction, thereby decreasing the ventricular rate during atrial fibrillation (9 patients), 2) as prophylaxis against paroxysmal atrial fibrillation (8 patients), 3) as prophylaxis against recurrence of atrial fibrillation after DC conversion to sinus rhythm (13 patients). All patients were considered refractory to other antiarrhythmic drugs in these respects. In the second group, 4 of the 8 patients reported complete cessation of attacks and the others a marked reduction of the attack rate. In the third group, 10 of the 13 patients have maintained sinus rhythm for a longer period on treatment with amiodarone than with other drugs, resulting more than a triple prolongation of the time in sinus rhythm. In 3 patients the drug has been discontinued because of side-effects. In conclusion, amiodarone affords protection from episodes of paroxysmal atrial fibrillation, as well as from recurrence of atrial fibrillation after DC conversion to sinus rhythm. If the drug is ineffective in either of these respects, it may still be useful as a means of moderating the ventricular response in atrial fibrillation.     

The sick sinus syndrome. Clinical and electrocardiographic spectrum of nine patients

The paper presents a report on the clinical and electrographic spectrum of nine patients with the sick sinus syndrome with severe symptoms of clinical disturbances and serious disorders of impulse formation and conduction. Seven patients had syncope associated with sinus bradycardia, sinoatrial block or atrial fibrillation with slow ventricular rate. Prolonged episodes of atrial and ventricular asystole occurred and were interrupted by junctional escape beats. Paroxysmal atrial fibrillation and flutter were foun in three patients and infrahisian block in four. Atropine induced a slight acceleration of the heart rate in all the patients studied while the post-suppression S-A node recovery time was prolonged in four.