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。

Using Dynamic electrocardiogram to analyze the Electrocardiograph Triggering of Paroxysmal atrial fibrillation

Objective To explore the touching off factors and sites of paroxysmal atrial fibrillation(PAf) and their clinical significance.Methods Artificially replay the Dynamic electrocardiogram of 45 cases of PAf,record the time of atrial fibrillation(Af),and identify the site of atrial premature beat(APB).Results There were 248 attach in the 45 cases.The factors that trigger PAf include APB 84.97%,sinus brabycardia 7.73%,atrial flutter 2.14%,tachycardia 2.57%.The siles of APB include upper left atrial 69.96%,lower left atrial 12.02%,upper right atrial 9.87%,and lower right atrial(3.86%.) The attach of PAf had tow perks:23:00～1:00 and 9:00～11:00,and one recession:13:00～15:00.Most PAf attach were seen short-long-short cycle 21.89%.Conclusion Uperleft PAB is the major touching factor of PAf.Long and short cycle is an important initiating mechanism.Dynamic electrocardiogram is very helpful for the treatment of PAf.