快速性房性心律失常Lorenz-RR散点图形态特征分析  

Analysis on morphological characteristics of Lorenz-RR scatter plot in patients with rapid atrial arrhythmia

作　　者：郑文凯[1] 康虹[1] 许智永[1] ZHENG Wenkai;KANG Hong;XU Zhiyong(Department of Electrocardiogram,Zhangzhou Municipal Hospital of Fujian Province,Zhangzhou Fujian 363000,China)

机构地区：[1]福建省漳州市医院心电图室,福建漳州363000

出　　处：《实用心电学杂志》2022年第1期37-42,共6页Journal of Practical Electrocardiology

摘　　要：目的探讨快速性房性心律失常Lorenz-RR散点图的形态特征及形成机制。方法选取经动态心电图检查诊断为快速性房性心律失常的73例患者,其中,房性心动过速(简称房速) 7例,房性扑动(简称房扑) 32例,不纯性房扑13例,房扑-房颤21例。采用DMS公司12导联动态心电图记录仪及分析软件,对全部心搏Lorenz-RR散点图进行回顾性研究,并对各分组病例的散点图特征进行归纳总结。分析各类快速性房性心律失常的心电图特征、FF间期、心房频率、F波形态种类、是否存在等电位线,及其与Lorenz-RR散点图图形特征的关系。结果 7例房速中,2例呈单个椭圆形,3例呈多分布椭圆形,2例呈网格状团块。32例房扑中,2例呈多分布椭圆形,26例呈清晰网格状团块,4例呈模糊网格状团块。13例不纯性房扑中,2例呈清晰网格状团块,10例呈模糊网格状团块,1例呈含有模糊团块的扇形。房扑-房颤呈含有模糊团块的扇形,或是无团块的扇形。结论快速性房性心律失常Lorenz-RR散点图形态特征与房性周期的频率和规律性相关,也与房室结不应期的变化有关。当心房频率较慢且规律时,散点图呈单个或多分布椭圆形团块;当心房频率较快且规律时,呈清晰网格状团块。当心房频率逐渐失去规律性时,团块边界逐渐模糊:由清晰网格状团块发展为模糊网格状团块,再发展为有或无团块的扇形。团块的多少与房室传导比例有关,单个团块的扩大或扩散受房性周期变异性和房室结不应期变化的影响。Objective To investigate the morphological characteristics of Lorenz-RR scatter plot in patients with rapid atrial arrhythmia and its formation mechanism. Methods We selected 73 patients diagnosed with rapid atrial arrhythmia by ambulatory electrocardiography( AECG) examination,including 7 cases of atrial tachycardia,32 cases of atrial flutter,13 cases of impure atrial flutter and 21 cases of atrial flutter-atrial fibrillation. By using 12-lead AECG recorder and analysis software produced by DMS company,retrospective study was carried out on Lorenz-RR scatter plots with all the heart beats. The characteristics of scatter plots in each group were summarized. We analyzed the ECG features,FF interval,atrial frequency,morphological types of F wave,the presence or absence of equivalent potential line,and their association with morphological characteristics of Lorenz-RR scatter plot. Results Among the 7 cases of atrial tachycardia,2 are presented as individual ellipses,3 are multi-distributional ellipses,and 2 look like grid-shaped block masses. Among the 32 cases of atrial flutter,2 are presented as multidistributional ellipses,26 are clear grid-shaped block masses,and 4 are vague grid-shaped block masses. In the 13 cases of impure atrial flutter,2 look like clear grid-shaped block masses,10 are vague grid-shaped block masses,and one is fan-shaped with vague block masses. The scatter plot of atrial flutter-atrial fibrillation is fan-shaped with vague block masses or without block mass. Conclusion The morphological characteristics of Lorenz-RR scatter plot in patients with rapid atrial arrhythmia are related to the frequency and regularity of atrial cycle,and are also associated with changes of atrioventricular node refractory period. At a slow and regular atrial frequency,the scatter plot is presented as individual or multi-distributional elliptic block mass;at a quick and regular atrial frequency,it looks like clear grid-shaped block mass. With a loss of regularity in atrial frequency,the boundary of block mass gradu

关 键 词：房性心动过速 心房扑动 房性周期 房室传导 Lorenz-RR散点图 

分 类 号：R541.7[医药卫生—心血管疾病]