联合运用3种心电散点图快速解析特殊复杂心律失常  

Joint use of three kinds of ECG scatter plots in rapid analysis of special complex arrhythmia

作　　者：景永明[1] Jing Yong-ming(Department of Electrocardiogram,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450014,China)

机构地区：[1]郑州大学第二附属医院心电图科,河南郑州450014

出　　处：《实用心电学杂志》2020年第4期247-252,共6页Journal of Practical Electrocardiology

基　　金：河南省科技厅资助项目(102102310179)。

摘　　要：目的探讨联合运用3种心电散点图快速解析特殊复杂心律失常的优势,积累复杂心律失常的分析经验。方法以特殊的房性并行心律为例,分别查看其时间散点图、Lorenz散点图及差值散点图,结合逆向技术及散点图数学模型分析其心动周期特征,解析其心电散点图特征及形成原理,分析和总结心电散点图所表现出的电生理意义,明确心律失常的性质。结果3种心电散点图各具特征。时间散点图:时而分2层,时而分3层;2层时段为房性早搏二联律(底层为NS层、顶层为SN层),3层时段显示房性心律占主导地位(SS层基本居于NS层与SN层正中),可知代偿间期与联律间期之和等于房律周期的2倍,即SN+NS=2SS。Lorenz散点图:粉色点集占优势(占心搏总数的2/3),分布于短长周期区及等速线附近;蓝色点集占劣势(占心搏总数的1/3),分布于长短周期区及等速线附近,数学模型显示粉色点集为互有重叠的三分布,其余特征不明显。差值散点图:特征性极强,类似频发室性早搏二、三联律的差值散点图顺钟向旋转180°。散点图的宏观视野表明:房性心律的自律性达到或略超窦性心律而占主导地位;房性心律在间歇性传出阻滞时,窦性心律以逸搏的形式出现,但并没有打乱其节律,提示本例房性心律有保护性传入阻滞,为自律性增高的房性并行心律。结论3种心电散点图联合运用,为特殊复杂病例的分析提供了宏观视野,散点图所揭示的电生理意义为心律失常定性提供了依据。在复杂心律失常的快速分析中,联合运用3种心电散点图优势明显。Objective To explore the advantages of the joint use of three kinds of ECG scatter plots in rapidly analyzing special complex arrhythmias,and to accumulate experience of complex arrhythmia analysis.Methods Taking special atrial parasystolic rhythm as an example,its time scatter plot,Lorenz scatter plot and difference scatter plot were separately observed.Based on a combination of reversal technique and mathematical model of scatter plot,the characteristics of cardiac cycle,and features and formation principle of ECG scatter plot were analyzed.The electrophysiological significance reflected by ECG scatter plot was analyzed and summarized which helps to identify the nature of arrhythmias.Results The three kinds of ECG scatter plots have their own characteristics.Time scatter plot:it is sometimes divided into two layers and sometimes divided into three layers.Within the time period corresponding to two layers,the scatter plot is presented as atrial bigeminy(the bottom layer is NS,and the top layer is SN)while atrial rhythm dominates the time period corresponding to three layers(layer SS is basically located in the middle of layer NS and SN).It implies that the compensatory interval added to coupling interval is equal to twice of the atrial rhythm cycle,that is,SN+NS=2SS.Lorenz scatter plot:the pink point set shows to be dominant(accounting for 2/3 of the total heart beats),and distributes neighboring to the short-long period zone and constant velocity line.The blue point set is disadvantaged(accounting for 1/3 of the total heart beats),and distributes neighboring to the long-short period zone and constant velocity line.Mathematical model reveals that the pink point set embraces three overlapping components and no other obvious characteristic is found.Difference scatter plot:it is similar to make a 180°clockwise rotation of the difference scatter plot of bigeminy and trigeminy of frequent premature ventricular contraction with distinctive features.From a macroscopic view of scatter plot,atrial rhythm occupies a pred

关 键 词：窦性心律 特殊复杂心律失常 时间散点图 LORENZ散点图 差值散点图 房性并行心律 动态心电图 

分 类 号：R540.41[医药卫生—心血管疾病]