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。

Characteristics of Ambulatory Electrocardiogram in Patients with Chronic Atrial Fibrillation and Optimal Ventricular Rate Control

Objective:To observe the characteristics of 24 hour ambulatory electrocardiogram in patients with chronic atrial fibrillation (AF) and optimal ventricular rate control. 　　Methods:Holter monitoring was performed in 122 hospitalized patients,aged 17—85 (mean 51.57±11.94) years,with organic heart disease and chronic AF (New York Heart Association functional class Ⅱ-Ⅲ) in whom the ventricular rate were well-controlled by digoxin.Maximum,minimum and mean ventricular rates,the number of ventricular pauses of ＞1.5 second,and the longest ventricular pauses during the monitoring were recorded.Follow-up data were collected in 72 patients. 　　Results:The mean,fastest and lowest ventricular rates over 24 hours were 78.53±8.12(65—90)，143.79±28.85(90-183) and 51.04±7.52(34—71) bpm,respectively.Bradycardia of less than 50 and 45 bpm occurred in 62 and 32 of the 122 patients,respectively.Ventricular pauses of more than 1.5 and 3.0 seconds were noted in 95 and 14 of the 122 patients,respectively.The longest ventricular pause was 2.38±0.55(4.64—1.60) seconds.During follow-up,there were no worsening in these patients. 　　Conclusion:Ventricular pauses at rest and nocturnal bradycardia were common in patients with chronic atrial fibrillation who had ventricular rates controlled.The dosage of digoxin should not be changed,nor pacemaker insertion is needed.