121例老年房颤患者的动态心电图特征及相关因素分析

Ambulatory Electrocardiogram Characteristics and Analysis of Associated Factors among 121 Elderly Patients with Atrial Fibrillation

摘要: 目的：分析老年房颤患者的心律失常特征及相关因素，为改进老年人群房颤的防治提供科学依据。方法：连续入选2017年1月至2019年12月，入住云南省老年病医院，确诊为房颤的65岁以上患者共121例，分为阵发性房颤组和持续性房颤组进行比较。结果：1) 阵发性房颤组>1.5 s RR间期频次高于持续性房颤组(p < 0.05)，总心搏数、最大心率、平均心率、最小心率、最长RR间期、>2.0 s RR间期均无显著性差异。2) 31例阵发性房颤患者共发作44阵阵发性房颤，除5次骤然发作外，39阵发作的触发因素为房性早搏(71.79%)。3) 持续性房颤组的超声心动图测值LAD、LVDD、RAD、RVD均高于阵发性房颤亚组(p均<0.05)，LVEF、基础疾病等均无组间显著性差异。4) 121例患者，81例(66.94%)接受抗栓相关的药物治疗，40例(33.06%)未接受任何抗栓药物治疗。5) 与老年持续性房颤存在正相关的因素是LAD增大。结论：阵发性房颤更易被房性早搏触发，更易发生房颤长RR间期。左房增大、右房增大、左室增大、右室增大均可能是老年持续性房颤的易患因素，左房内径越大越易形成持续性房颤。老年房颤患者抗凝治疗存在不充分、不规范、依从性差等重大缺陷，随访管理亟待改进和加强。

Abstract: Objective: To analyze the arrhythmia characteristics and related factors of elderly patients with atrial fibrillation, and to provide a scientific basis for improving the prevention and treatment of atrial fibrillation in the elderly. Methods: Between January 2017 and December 2019, a total of 121 patients aged 65 and above were diagnosed with atrial fibrillation upon admission to the Geriatric Hospital of Yunnan province. These patients were categorized into two groups, paroxysmal atrial fi-brillation and persistent atrial fibrillation, for comparison. Results: 1) Paroxysmal atrial fibrillation had more >1.5 s RR interval than persistent atrial fibrillation (p < 0.05), and there was no signifi-cant difference in total cardiac beats, maximum heart rate, mean heart rate, minimum heart rate, longest RR interval, and >2.0 s RR interval. 2) Thirty-one patients with paroxysmal atrial fibrillation had 44 paroxysmal atrial fibrillation episodes. Except for 5 sudden episodes, the trigger factor of 39 paroxysmal atrial fibrillation was atrial premature beat (71.79%). 3) The electrocardiographic val-ues of left atrial enlargement, right atrial enlargement, left ventricular enlargement and right ven-tricular enlargement in the persistent atrial fibrillation group were higher than those in the parox-ysmal atrial fibrillation subgroup (p < 0.05), and there was no significant difference in LVEF or un-derlying disease. 4) Of 121 patients, 81 (66.94%) received antithrombotic-related medication, and 40 (33.06%) did not receive any antithrombotic medication. 5) The factor positively associated with persistent atrial fibrillation in old age was enlarged left atrial enlargement. Conclusion: Paroxysmal atrial fibrillation is more easily triggered by atrial premature beats and more prone to long RR in-terval. Left atrial enlargement, right atrial enlargement, left ventricular enlargement and right ventricular enlargement may be the susceptibility factors of persistent atrial fibrillation in the left atrial diameter, the more likely to form persistent atrial fibrillation. Elderly patients with atrial fi-brillation have major defects, such as insufficiency, non-standard and poor compliance, and fol-low-up management needs to be improved and strengthened.