Lu Ping, Mo Xingchun, Yang Xiaojing, Lin Yaoyao
Department of Cardiology, Linping Campus, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Int J Gen Med. 2025 May 8;18:2487-2495. doi: 10.2147/IJGM.S515113. eCollection 2025.
Exploring the independent risk factors of second-degree atrioventricular block (II AVB) in patients with atrial fibrillation (AF), and to evaluate the clinical value of 24-hour dynamic electrocardiogram (DCG) in its diagnosis.
A prospective cohort study was conducted on 947 patients with AF diagnosed and treated in our hospital from January 1, 2021 to December 31, 2021. These patients were divided into combined group (98 cases) and uncombined group (849 cases) according to whether they were accompanied by. The clinicopathological data of the patients were collected, and Multivariate logistic regression analysis was used to analyze the independent risk factors. Patients in combined group were further evenly divided into the study group (underwent 24-hour DCG) and the control group (underwent routine ECG) based on the detection methods. The diagnostic value was valued and the positive detection rate was calculated by ROC curve.
The smoking history, left atrial internal diameter (LAD), R-R interval and ventricular rate of patients in two groups had significant differences (<0.001). Smoking history (HR=1.531, 95% CI 1.150-2.038, <0.001), LAD>35.88 mm (HR=1.941, 95% CI 1.301-2.895, <0.001), R-R interval>2.50 s (HR=2.282, 95% CI 1.231-4.229, =0.014) were independent risk factors for AF combined with II AVB, while ventricular rate≤70 beats/min (HR=0.506, 95% CI 0.293-0.873, =0.014) were independent protective factors for AF combined with II AVB. The mean ventricular rate (70.03±5.40 beats/min vs 83.11±8.05 beats/min, <0.001) and R-R interval (2.82±0.26s vs 2.37±0.14s, <0.001) in the study group were longer than the control group. The diagnostic positive rate of DCG (97.96% vs 85.71%, ²=4.900, =0.027) was higher than that of conventional ECG.
Smoking history, LAD, R-R interval and ventricular rate were influential factors for AF combined with II AVB. 24-h DCG had potential diagnostic value in the occurrence of AF combined with II AVB.
探讨心房颤动（AF）患者发生二度房室传导阻滞（II AVB）的独立危险因素，并评估24小时动态心电图（DCG）在其诊断中的临床价值。
对2021年1月1日至2021年12月31日在我院确诊并治疗的947例AF患者进行前瞻性队列研究。根据患者是否伴有II AVB将其分为合并组（98例）和未合并组（849例）。收集患者的临床病理资料，采用多因素logistic回归分析独立危险因素。合并组患者根据检测方法进一步平均分为研究组（行24小时DCG）和对照组（行常规心电图）。采用ROC曲线评估诊断价值并计算阳性检出率。
两组患者的吸烟史、左心房内径（LAD）、R-R间期及心室率比较，差异有统计学意义（<0.001）。吸烟史（HR=1.531，95%CI 1.150-2.038，<0.001）、LAD>35.88 mm（HR=1.941，95%CI 1.301-2.895，<0.001）、R-R间期>2.50 s（HR=2.282，95%CI 1.231-4.229，=0.014）是AF合并II AVB的独立危险因素，而心室率≤70次/分（HR=0.506，95%CI 0.293-0.873，=0.014）是AF合并II AVB的独立保护因素。研究组的平均心室率（70.03±5.40次/分 vs 83.11±8.05次/分，<0.001）和R-R间期（2.82±0.26s vs 2.37±0.14s，<0.001）长于对照组。DCG的诊断阳性率（97.96% vs 85.71%，²=4.900，=0.027）高于常规心电图。
吸烟史、LAD、R-R间期及心室率是AF合并II AVB的影响因素。24小时DCG对AF合并II AVB的发生有潜在诊断价值。
