当代心脏植入装置记录的高频心房事件腔内电图分析  

Intracavitary electrogram analysis of atrial high rate episodes recorded by contemporary cardiac implantation devices

作　　者：吴冬燕[1] 李丽华[1] 何乐[1] 张洁[1] 马薇[1] 樊少博[1] 卢凤民[1] 许静[1] Wu Dongyan;Li Lihua;He Le;Zhang Jie;Ma Wei;Fan Shaobo;Lu Fengmin;Xu Jing(Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院心内科,300222

出　　处：《中华心律失常学杂志》2021年第4期317-321,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：天津市卫生计生委科技攻关项目(16KG134)。

摘　　要：目的评估当代具备心腔内电图存储功能的双腔或三腔起搏器中记录的心房高频事件(AHRE)与心房颤动(房颤)、心房扑动(房扑)的相关性。方法收集2015年1月到2020年12月天津市胸科医院植入双腔或三腔起搏器的2109例患者记录的2440份AHRE腔内电图,记录心房发作频率和持续时间并分析其种类。结果平均随访2.3年,有23.9%的患者记录到了≥30 s的AHRE,2440份AHRE腔内电图中房扑/房颤发作2111份图(86.5%,2111/2440),交叉感知21份图(0.9%,21/2440),噪声干扰64份图(2.6%,64/2440),房性心动过速(房速)237份图(9.7%,237/2440),重复性非折返性室-房同步节律5份图(0.2%,5/2440),2份未确定类型(0.1%,2/2440)。AHRE持续时间>6 h并且频率≥250次/min对房扑/房颤的阳性预测值为99.9%。结论结合时间和频率分析的AHRE是诊断房颤、房扑的可靠工具。Objective To evaluate the relationship between the atrial high rate episodes(AHRE)and atrial fibrillation(AF)or atrial flutter(AFL)in contemporary pacemakers.Methods The study included 2109 patients implanted pacemakers which could supply intracavitary electrogram during follow-up period in Tianjin Chest Hospital from January 2015 to December 2020.All AHRE recorded with available electrograms were reviewed to determine whether they represented true AF/AFL.The distribution,different rates and durations of AHRE were analyzed.Results Of 2440 AHRE≥30 s and≥160 beats/min,86.5%(2111/2440)were true AF/AFL.Other false positives included atrial tachycardia(9.7%,237/2440),noise(2.6%,64/2440),cross sensing(0.9%,21/2440),repetitive non-reentrant ventricular atrial synchrony rhythm(0.2%,5/2440),uncertainty(0.1%,2/2440).By using a cutoff of≥250 beats/min and>6 h,the positive predictive value of AHRE was 99.9%.Conclusion AHRE combined with time and frequency analysis is a reliable tool for the diagnosis of AF/AFL.

关 键 词：心房颤动 心脏起搏器 人工 心房高频事件 自动模式转换 

分 类 号：R541.7[医药卫生—心血管疾病]