延长动态心电图检测时间对慢性心力衰竭患者心律失常检出率的影响

摘要

目的:比较不同时程动态心电图记录对慢性心力衰竭患者的心律失常检出率上的差异.方法:连续纳入2016-01至2016-09在我院老年病科住院慢性心力衰竭患者108例,行连续72小时动态心电图监测.并进一步按纽约心脏协会(NYHA)心功能分级、左心室射血分数(LVEF)以及N末端B型利钠肽原(NT-proBNP)水平分组,比较监测第24小时、第48小时及第72小时室上性及室性心律失常的检出率.结果:患者按NYHA心功能分级分:心功能Ⅱ级40例,Ⅲ级42例,Ⅳ级26例.按NT-proBNP水平分,≥1000 pg/ml者54例,<1000 pg/ml者54例.按射血分数分:射血分数保留的心力衰竭(HFpEF)80例,射血分数中间值的心力衰竭(HFmrEF)13例,射血分数降低的心力衰竭(HFrEF)15例.对短阵房性心动过速(NSAT)检出率,监测进行到第48小时(81.7%)与第24小时(64.6%)两者间差异有明显统计学意义(P<0.01).对新发阵发性心房颤动,通过24小时检出1例,监测至第72小时,有额外3例检出.对短阵室性心动过速(NSVT)的检出率,监测进行到第72小时(38%)与第24小时(25.9%)两者相比差异才有统计学意义(P<0.01).分组比较发现,72小时与24小时动态心电图对于心功能Ⅲ级心力衰竭患者,对NSVT的检出率差异有统计学意义(P<0.05),但在心功能Ⅳ级患者,对NSVT的检出率差异未见统计学意义(P>0.05).结论:长程(72小时/48小时)动态心电图对心力衰竭患者的各类心律失常检出率更高,但心力衰竭程度越重,24小时动态心电图越易发现NSVT.对中重度心力衰竭患者如24小时动态心电图未发现NSVT,可适当延长检测时间,将有利于指导患者的临床治疗.%Objective: To compare the detection rate of arrhythmia in chronic heart failure (CHF) patients by different time of ambulatory electrocardiogram (Holter). Methods: A total of 108 consecutive elderly CHF patients received 72h Holter in our hospital from 2016-01 to 2016-09 were enrolled. According to NYHA classification, LVEF and plasma NT-proBNP level, the patients were divided into 3 sets of groups. Detection rates of supra-ventricular arrhythmia and ventricular arrhythmia were compared among 24h, 48h and 72h Holter recording. Results: Based on NYHA classification, the patients were divided into 3 groups: NYHA Ⅱ group, n=24, NYHAⅢ group, n=42 and NYHAⅣ group, n=26; based on NT-proBNP level, the patients were divided into 2 groups: NT-proBNP≥1000 pg/ml group and NT-proBNP<1000 pg/ml group, n=54 in each group; based on LVEF, the patients were divided into 3 groups: HFpEF group, n=80, HFmrEF group, n=13 and HFrEF group, n=15. Detection rate for non-sustained atrial tachycardia (NSAT) was 81.7% by 48h Holter which was higher than 64.6% at 24h, P<0.01; for non-sustained ventricular tachycardia (NSVT) was 38% at 72h which was higher than 25.9% at 24h, P<0.01. For new-onset paroxysmal atrial fibrillation, only 1 patient was detected by 24h Holter and the additional 3 patients were detected by 72h. Group analysis indicated that the detection rate of NSVT was different by 72h and 24h Holter in NYHA Ⅲ patients, P<0.05; while it was similar in NYHA Ⅳ patients, P>0.05. Conclusion: Long term (72h/48h) Holter had the higher detection rate of arrhythmia in HF patients, 24 h monitoring was easier to find NSVT in severer HF patients. In moderate to severe HF patients, the detection time may be prolonged if NSVT couldn't be found by 24h Holter which was helpful for clinical treatment.