心电瀑布图在快速识别病态窦房结综合征各种逸搏心律中的应用  

Rapid identification of various escape rhythms in sick sinus syndrome by ECG waterfall diagram

作　　者：赵瑞 马凌 焦丕奇 曾伟华 景永明[3] 刘津 ZHAO Rui;MA Ling;JIAO Piqi;ZENG Weihua;JING Yongming;LIU Jin(Department of Electrocardiogram,the 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army,Lanzhou Gansu 730050;Department of Oncology,the 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army,Lanzhou Gansu 730050;Department of Electrocardiogram,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450014;Department of Electrocardiogram,West China Second University Hospital,Sichuan University,Chengdu Sichuan 610041,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院心电图科,甘肃兰州730050 [2]中国人民解放军联勤保障部队第九四〇医院肿瘤科,甘肃兰州730050 [3]郑州大学第二附属医院心电图科,河南郑州450014 [4]四川大学华西第二医院心电图室,四川成都610041

出　　处：《实用心电学杂志》2024年第4期400-404,共5页Journal of Practical Electrocardiology

基　　金：甘肃省卫生健康行业科研项目(GSWSKY2020-01);医院高原高寒相关心血管系统疾病临床医学研究中心项目(2021yxky080)。

摘　　要：目的探讨房性、室性、交界性逸搏心律的心电瀑布图特征,为快速分析病态窦房结综合征(sick sinus syndrome,SSS)等缓慢性心律失常的动态心电图奠定基础。方法选择合并有上述三种逸搏心律的SSS病例,在常规观察其心电散点图的基础上,进一步分析其心电瀑布图特征;结合心电瀑布图的逆向技术,分析和总结三种逸搏心律的心电瀑布图特征及其与相应心电图的对应关系。结果SSS患者在窦房阻滞或窦性停搏的背景下出现的这三种保护性逸搏心律(房性、室性、交界性逸搏心律)的频率接近,相互竞争、反复交替,其心电散点图、RR间期直方图等常用分析工具揭示的特征不明显,但各种心律的心电瀑布图却特征各异,为快速分析此类病例提供了捷径。正常窦性心律的R峰带水平居中,宽度小于120 ms,色谱代表QRS波群的高度;P峰带、T峰带平行分居于R峰带上下,宽度与色谱分别代表P波、T波的时限和极性。窦性心律的三峰带心电瀑布图宽度、色谱若有变化,则意味着节律变换,其中房性逸搏心律的心电瀑布图特征为P峰带变色,R峰带、T峰带正常;室性逸搏心律的心电瀑布图特征为P峰带消失,R峰带变宽变色、T峰带变色;交界性逸搏心律的心电瀑布图特征为P峰带消失,R峰带、T峰带正常。结论心电瀑布图可用于快速识别SSS患者中的各类逸搏心律,在心电大据分析中能弥补心电散点图及RR间期直方图的不足。Objective To explore the characteristics of atrial,ventricular and junctional escape rhythms in ECG waterfall diagram,and to lay a foundation for rapidly analyzing ambulatory electrocardiography of chronic arrhythmias such as sick sinus syndrome(SSS).Methods A patient diagnosed with SSS complicated by the above three escape rhythms were selected.The characteristics of ECG waterfall diagram were further analyzed based on the routine view of the ECG scatter plots.Combined with the reversal technique of ECG waterfall diagram,we analyzed and summarized the characteristics of ECG waterfall diagrams of the three escape rhythms,and their correspondence with the corresponding ECGs.Results Under the background of sinus block or sinus arrest,the frequencies of the three protective escape rhythms(atrial,ventricular and junctional escape rhythms) in the patient with SSS were close,competing with each other and alternating repeatedly.The characteristics revealed by the common analytical tools such as ECG scatter plot and RR interval histogram were not obvious,but the features of the ECG waterfall diagram of each rhythm were different which provided a shortcut to rapidly analyze this kind of cases.The R-peak band of normal sinus rhythm was horizontally centered and its width was 120 ms or less.The chromatogram represented the height of QRS complex.The P-and T-peak bands were in parallel,separately located at the upper and the bottom of R-peak band.The width and chromatography represented the duration and polarity of P-and T-waves,respectively.Rhythm transformation was indicated by the changes of the width or chromatography of the three-peak-band ECG waterfall diagram of sinus rhythm.The ECG waterfall diagram characteristics of atrial escape rhythm were as follows:P-peak band was allochroic while R-and T-peak bands were normal.The ECG waterfall diagram characteristics of ventricular escape rhythm were as follows:P-peak band disappeared,R-peak band was widened and allochroic,and T-peak band changed its color.The ECG waterfall di

关 键 词：动态心电图 心电散点图 心电瀑布图 病态窦房结综合征 房性逸搏心律 室性逸搏心律 交界性逸搏心律 

分 类 号：R541.7[医药卫生—心血管疾病] R540.4[医药卫生—内科学]