【摘要】 目的应用24h动态心电图观察阵发性房颤发作的特征,进一步了解阵发性房颤的启动机制。方法阵发性房颤患者55例,观察房颤发作开始有无触发性房早,并测量其偶联间期(CI)及早搏指数(PI);记录触发性房早在V1导联的极性;观察房颤发作前是否存在心动过缓事件。结果阵发性房颤共计128阵。90.6%的阵发性房颤发作前均可见触发性房早,其联律间期(464±53ms)及早搏指数(0.41±0.06)明显短/小于非触发性房早(CI为509±50ms,p<0.05;PI为0.54±0.09,p=0.002)。92.2%的触发性房早其V1导联P波呈正向(+),提示左房起源。87.5%的阵发性房颤发作前存在心动过缓,其中69.6%为房早后的代偿间期,余为窦性心动过缓。结论阵发性房颤绝大多数由房早诱发,且触发性房早的联律间期更短,早搏指数更小;大部分阵发性房颤发作前存在心动过缓,且以房早后的代偿间期为主,其次为窦性心动过缓。更多还原

【Abstract】 Objective To evaluate the mechanism of induction of paroxysmal atrial fibrillation(PAF) by observing electrophysiological character of its onset with ambulatory electrocardiogram(AECG) . Methods AECG recordings of 55 patients with PAF were analyzed. A triggering premature atrial complex(PAC) at the beginning of each episode of PAF was detected. The coupling interva(lCI) and prematurity index(PI) were measured. Polarity of triggering PAC was recorded in lead V1. Bradyarrhythmic event before onset was also observed. Results 128 episodes of PAF were analyzed. A triggering PAC was present in 90.6% episodes,and CI(464±53ms) and PI(0.41±0.06) of triggering PACs were significantly shorter than those of non-triggering PAC(CI=509±50ms,p<0.05;PI=0.54±0.09,p=0.002) . 92.2% triggering PACs were left atrial origin according to the positive polarity in lead V1. Bradyarrhythmic event before onset was present in 87.5% episodes,with 69.6% of which was postextrasystolic pause,and the others sinus bradycardia. Conclusion PAF is generally triggered by a PAC and CI and PI of triggering PACs are shorter. Bradyarrhythmia was present before onset of most episodes of PAF,including primary post-extrasystolic pause and secondary sinus bradycardia.更多还原