心房颤动伴长R-R间期患者动态心电图特点及预后分析

摘要

Objective To investigate dynamic electrocardiogram characteristics and prognosis in patients with atrial fibrillation complicated with long R-R interval.Methods Totally 115 patients in Beijing Anzhen Hospital,Capital Medical University from August 2015 to December 2015 were enrolled.The dynamic electrocardiogram examination revealed atrial fibrillation with long R-R interval (＞ 2 s).Age and long R-R interval distribution were analyzed.According to the occurrence time of long R-R interval,all patients were divided into sleep related group and non-sleep related group.In sleep related group,R-R interval only occurred between 21:00-6:00;in non-sleep related group,R-R interval occurred anytime.Electrocardiogram characteristics and follow-up data were analyzed between groups.Results Long R-R interval could occur in elderly patients with atrial fibrillation,especially between 21:00-6:00.The lowest ventricular rate,the highest ventricular rate,average ventricular rate and times of long R-R interval had significant differences between sleep related group (53 cases) and non-sleep related group (62 cases) (P ＜ 0.05).In sleep related groups,no patient had amaurosis syncope symptom;17 patients got cardioversion and 16 cases among them showed normal dynamic cardiogram performances;1 case was diagnosed of first-degree atrioventricular block;12 patients showed no long R-R interval.In non-sleep related group,amaurosis syncope occurred to 2 patients and they got recovery after artificial pacemaker implantation in hospital;3 patients had second-and third-degree atrioventricular block after cardioversion;1 patient still showed long R-R interval.Conclusion Atrial fibrillation patients with long R-R intervals and low heart rates need regular follow-ups.%目的 探讨心房颤动伴长R-R间期出现原因及预后.方法 选取2015年8-12月首都医科大学附属北京安贞医院门诊及住院患者动态心电图检查显示心房颤动伴＞2s长R-R间期的患者115例,分析所有患者年龄及长R-R间期发生时间分布.依据动态心电图结果中＞2s长R-R间期出现时间将患者分为睡眠相关组与非睡眠相关组,睡眠相关组长R-R间期仅出现在21:00-6:00,非睡眠相关组长R-R间期可出现在其他时间段.对2组患者进行电话随访并比较相关资料.结果 老年心房颤动患者出现长R-R间期可能性大,在夜间长R-R间期出现频率高且集中在21:00-6:00.睡眠相关组(53例)与非睡眠相关组(62例)最慢心室率、最快心室率、平均心室率和非睡眠时段及睡眠时段出现长R-R次数比较,差异均有统计学意义(均P＜0.05).对2组患者进行电话随访,睡眠相关组随访中无一例患者出现黑朦晕厥症状,其中17例成功复律,复律后复查动态心电图16例正常,1例诊断为Ⅰ度房室传导阻滞;另有12例患者复查动态心电图,无长R-R间期出现.非睡眠相关组2例在随访中出现黑矇晕厥症状,住院后植入人工起搏器,治疗后症状消失;3例患者复律后出现Ⅱ度及以上房室传导阻滞,1例复查动态心电图出现＞6s长R-R间期,这4例患者均植入人工起搏器.结论 心房颤动患者出现长R-R间期与睡眠相关是由于生理原因造成.若心房颤动患者活动状态中出现长R-R间期并且平均心率较低,应当予以高度重视,无症状者应定期随访,有晕厥症状者应植入永久起搏器,符合起搏器植入指征者应当予以起搏器植入.