Clinical Study Of Non-Valvular Atrial Fibrillation With Long R-R Interval

Objective:To explore the mechanism and clinical significance of NVAF patients with long R-R interval(?2s)by analyzing the characteristics,clinical characteristics and influencing factors of dynamic electrocardiogram(DCG)in non-valvular atrial fibrillation patients with long R-R interval?2s.To analyze the efficacy and safety of pulmonary vein isolation in the treatment of NVAF with long R-R interval(?2s),and to explore the pathogenesis of NVAF with long R-R interval(?2s).To investigate the correlation between non-valvular atrial fibrillation with long R-R interval(?2s)and left atrial/auricular thrombosis and SEC formation.Methods:(1)To retrospectively investigate,analyze and compare the dynamic electrocardiographic characteristics,clinical characteristics and influencing factors of NVAF patients with or without long R-R interval.(2)Retrospective analysis of therapeutic effect and influencing factors of pulmonary vein electrical isolation in NVAF patients with long R-R interval(?2s).(3)To screen biochemical parameters related to left atrial thrombosis,left atrialparametersmeasuredbytransthoracicandtransesophageal echocardiography,and to find independent risk factors for left atrial/auricular thrombosis and SEC formation in NVAF patients with long R-R interval(?2s).Result:(1)NVAFwithlonger R-R interval(?2s)is a common electrocardio-graphic phenomenon.Hypertension,coronary heart disease and diabetes are the main causes of NVAF with long R-R interval?2s.(2)Patients with long R-R interval(?2s)and the frequency?100 times/24h are more likely to be complicated with"II~o AVB".(3)The long R-R interval(?2s)of NVAF occurs mostly at 0Am-6Am,suggesting that the increased of vagal nerve tension isoneofthemechanisms.34.12%ofNVAFpatientshavelongR-R interval(?2s)during 24 hours,which is not related to sleep.It is considered as a concealed conduction mechanism,but it does not exclude the possibility of pathological conduction block.(4)"Average heart rate","HR>120 beats/min duration ratio","Holter's recorded as total atrial fibrillation","hypertension"and"left atrial diameter"as independent risk factors of NVAF with long R-R interval(?2s).(5)High suspicion of abnormal function of sinoatrial node and atrioventricular node was found in patients whose ECG average heart rate was less than 40 beats/min and long R-R interval was frequent and unrelated to sleep.(6)"Left atrial appendage opening length","pressure difference of maximum left atrial emptying velocity 1","leftsuperior pulmonary vein blood flow velocity"and"Holter record as whole course atrial fibrillation"were independent risk factors for left atrial thrombosis in NVAF.(7)"Red blood cell distribution width"is an independent risk factor for thrombosis in NVAF patients with long R-R interval(?2s).Conclusion:(1)The long R-R interval(?2s)of NVAF may be caused by concealed conduction,increased vagal nerve tension,overspeed inhibition,or the interaction of the three.(2)Patients with average heart rate<40 beats/min and frequent long R-R intervals unrelated to sleep were highly suspicious of abnormal function of sinoatrial node and atrioventricular node.(3)"Left atrial appendage opening length","pressure difference of maximum left atrial emptying velocity 1","left superior pulmonary venous flow velocity","Holter record as whole course atrial fibrillation"are independent risk factors for left atrial thrombosis in NVAF.(4)"Red blood cell distribution width"is an independent risk factor for thrombosis in NVAF patients with longer R-R interval?2s.