| Background:Atrial fibrillation is a common type of cardiac arrhythmia.It accounts for about30% of patients with arrhythmia in hospital.A number of large-scale heart failure test confirm that atrial fibrillation is dependent predictors of heart failure mortality and morbidity,the two have close relationship and reciprocal causation.Complete right bundle branch block is a common intraventriclar conduction block.In recent years,as for the patients with branch block(LBBB),with the further study of ventricular resynchronization therapy in patients with heart failure,we have a great recognition of cardiac electrical excitation mechanical function.While the right bundle branch is one of the important conduction pathways of the double chamber electro mechanical activity,but its effect on cardiac function has not been paid enough attention.At present,atrial fibrillation is considered to be an independent risk factor for prognosis,while complete right bundle branch block has little effect on prognosis.But studies have shown that atrial fibrillation associated with CRBBB has greater effection on cardiac function than the sinus rhythm with CRBBB.Our study aims to do further observation on heart function in patients with atrial fibrillation and CRBBB at different level of QRS duration.Objectives and Methods:In order to explore the significance of QRS duration in the evaluation of cardiac function of patients with atrial fibrillation and complete right bundle branch block,We continuously collected of 250 hospitalized patients diagnosed with atrial fibrillation and complete right bundle branch block in the First Affiliated Hospital of Dalian Medical University from January 2014 to July 2016.The 250 hospitalized patients are divided into three groups according to the QRS duration,group A(120ms≤QRS < 135ms),group B(135ms≤QRS<150ms)and group C(QRS≥150ms).And then explore the relationship between QRS duration and brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular diameter(LVD),left atrium diameter(LAD),right ventricular diameter(RVD),right atrium diameter(RAD).Results:The 250 patients are divided into three groups according to the QRS duration,they are group A(n=89),group B(n=82),group C(n=79).Analysis on the observation data,we obtain the following results:(1)In terms of the gender,150 patients are male,and other 100 patients are female,the ratio between them is 1.5:1.(2)In terms of the age,the overall average age is(71.21 ± 10.85)years old,most of them are the elderly.(3)In the aspect of cardiovascular system diseases,patients with hypertension,heart failure,coronary heart disease,accounted for 58%,51.2%,42.0% respectively,the proportion of patients with myocardial infarction,valvular heart disease,rheumatic heart disease and cardiomyopathy accounted for 23.6%,25.6%,7.6%,4.8% respectively.Based on the results above,we can see that heart failure,hypertension,coronary heart disease accounted for a large proportion,and the proportion of myocardial infarction,valvular disease are lower.(4)The BNP(ng/L)value of group A,B,C are 266.81(145.49-476.24)、232.05(124.39-520.46)、290.26(116.75-1056.55);The LVEF(%)value of group A,B,C are 54.66±7.74,54.01±7.60,48.97±11.58;the LVD(mm)of group A,B,C are46.30±6.57,49.38±6.74,52.95±9.3;the LAD(mm)of group A,B,C are 42.49±8.69,42.99±8.25,44.02±7.82;the RVD(mm)of group A,B,C are 19.35±4.913,19.89±5.144,20.64±5.368;the RAD(mm)of group A,B,C are 1756.50(1420.75-2472.75),2040(1768.00-2800.00),and 2162.50(1656.00-2845.50).As is shown above,with the increase of QRS duration,the average level of LVD,LAD,RVD and RAD tend to increase gradually,the average level of LVEF tend to decrease,the mean BNP level slightly decrease first,and then increase gradually.(5)We analysis on the observation data among the three groups with CHi-squared test or nonparametric ran and inspection test(Keuskal-Wallis Test): LVEF,LVD,RAD have differences in statistical significant,The P value are 0.014,0.000 and 0.020,the differences are significant.(6)The application of Pearson correlation analysis to compare the relevance of QRS duration and BNP,LVEF,LVD,LAD,RAD and RVD,the result shows that LVD(r=0.315,P=0.000),LAD(r=0.131,P=0.042),RVD(r=0.165,P=0.010),RAD(r=0.142,P=0.029),BNP(r=0.137,P=0.039)are all positively correlated,and the LVEF(r=-0.254,P=0.000)is negatively correlated.Conclusion:1.Patients of atrial fibrillation combined with complete right bundle branch block in the incidence of male patients is higher than that of women,the ratio is 1.5:1.Elderly patients with high disease rate and the average age(71.21±10.85)years old.2.Patients of atrial fibrillation combine with complete right bundle branch block often complicated with organic heart disease,such as hypertension,coronary heart disease,heart failure,myocardial infarction,valvular heart disease.3.AS for the patients of atrial fibrillation combine with complete right bundle branch block,with QRS duration prolonged obviously,The LVEF decreased significantly,left ventricular diameter increased,the influence on heart failure is greater. |
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