立体心电图分析阵发性房颤患者心房的电生理特性  

Three-dimensional electrocardiogram analysis of atrial electrophysiology properties in patients with paroxysmal atrial fibrillation

作　　者：蒋鹏[1] 夏云龙[1] 张树龙[1] 洪丽[1] 丛培鑫[1] 王莹琦[1] 高连君[1] 陈善研[2] 杨延宗[1] 

机构地区：[1]大连医科大学附属第一医院心内科,116011 [2]华中科技大学同济医学院,430030

出　　处：《临床心电学杂志》2009年第2期104-107,共4页Journal of Clinical Electrocardiology

摘　　要：目的应用立体心电图(three-dimensional electrocardiogram,3D-ECG)分析阵发性房颤患者心房传导时间、心房除极角度和振幅的变化。方法入选在住院的阵发性房颤患者13例,对照组患者15例。分别应用立体心电图仪记录窦律下的立体心电图,分析后比较两组患者心房传导时间,P波除极振幅及角度。同时记录患者入院时超声心动图中左心房内径数值进行比较。结果两组患者比较左心房内径无显著差异。阵发性房颤组与对照组心房传导时间分别为123.75±11.67msvs.111.39±13.52ms,两组比较有显著性差异(p<0.05)。而在心房除极角度、振幅上,两组无显著差异。与对照组比较,阵发性房颤组患者P环初始部的运行方向与泪点疏密程度无明显变化,但在P环中间至终末部分,P环运行方向及泪点疏密出现明显变化,并且可看到明显的曲折、弯曲。但在除极末20ms的振幅,房颤患者较对照组明显降低(0.05±0.013mvvs.0.036±0.014mv,p<0.05),除极末30ms、40ms处两组振幅无显著差异。结论阵发性房颤患者可以出现心房传导时间延长、心房除极末振幅的改变和立体三维P环运行方向及泪点疏密程度的变化,提示其相关的基质变化可能参与房颤的发生与维持。立体心电图机可以对心房传导时间及心房除极角度、振幅进行无创的整体评价。Objective We examined atrial electrophysiologic properties noninvasively by using three-dimensional electrocardiogram （3D-ECG） in patients with PAF to find whether there was any differences. Methods thirteen patients with lone PAF and fifteen patients with paroxysmal supraventricular tachycardia ablation without history of PAF. （control group） were recruited. 3D-ECG recording were made during sinus rhythm.Then we analysed the 3D-ECG and compared two groups of patients with atrial oonduction, atrial depolarization angle and P wave amplitude. Results There was no significant difference between two groups in the left atrial diameter. The atrial conduction was 123.75 ± 11.67ms in patients and 111.39 ± 13.52ms in controls （p〈0.05）. There was no significant differences concerning atrial depolarization angle and P wave amplitude, Compared with the control group, there was no significant changes in move direction and the density of tear points in P loop initial part of patients, but in the middle part to the terminal of P loop, there was significant difference in the move direction and density of tear points. And you can see the obvious twists and turns, and bending. In addition to the amplitude of the end 20ms of atrial depolarization was shorten （0.05 ± 0.013mV vs. 0.036 ± 0.014mV,p〈0.05 ）, but there was no significant changes of the end 30, 40ms. Conclusions There appears atrial conduction delay, amplitude of the end of atrial depolarization decreased. Indicated their possible involvement in the maintenance of the incidence of atrial fibrillation. Three-dimensional ECG can be used to analyse the atrial conduction and the angle or amplitude of atrial depolarization in whole.

关 键 词：心房颤动 心房传导时间 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]