AmericanHeartAssociationTaskForceonPracticeGuidelines.CatheterCardiovascInterv。2008,71:El-406.HansenS,RasmussenV,Torp-PedersenC。etaLQTintervalsandQTdispersiondeterminedfromal2-lead24-hourHolterre—cordinginpatientswithcoronaryarterydiseaseandpatientswithheartfailure.AnnNoninvasiveElectroeardiol,2008,13:22.307.HenkensIR.MouchaersKT,Vonk-NoordegraafA,eta1.ImprovedECGdetectionofpresenceandseverityofrightventficu—larpressureloadvalidatedwithcardiacmagneticresonanceimaging.AmJPhysiolHeartCircPhysiol,2008,294:H2150·H21578.SharkeySW,LesserJR,MenonM,eta1.Spectrumandsignificanceofelectrocardiographicpatterns,troponinlevels。andthrom—bolysiainmyocardialinfarctionframecountinpatientswithstress(takoqsubo)cardiomyopathyandeomparisenIothoseinpa-tientsviithST—elevationanteriorwallmyocardialinfarction.AmJCardi01.2008,101:1723.17289.KellerDI.Heartandsports:whencanitbedangerous?Praxis(Bern1994),2007,96:2041.204610.KitaokaH,DoiY,CaseySA,elaLComparisonofprevalenceofapicalhypertrophiccardiomyopathyinJapanandtheUnitedStates.AmJCardiol,2003,92:l183一118611.MakarovLM,GoditskaiaOV,KurylevaTA,etaLPrevalenceofelectrocardiographicalsignsofrightventriculararrhythmogenieDysplasi&Kardiologiia,2004,44:23-2812.RassiAJr,BassiA,BassiSG.PredictorsofmortalityinchronicChagasdisease:asystematicreviewofobservationalstudies.Circulation.2007,115:l101一l10813.ArringtonCB,T鲫iLY,MiniehLL。eta1.Anassessmentoftheelectrocardiogramasascreeningtestforlargeatrialseptalde-feetsinchildren.JEloctrocardiol。2007,40:484·48814.KarabagT,KiliPaslanI,AmlanAH.OsbomwavesinahypothermicpatientwithheadtrauIlnOsbernwavesinahypothermicpatientwithheadtrauma.CanJCardioI,2008,24:318-31915.WildeAA,AntzelevitehC,BorggrofeM,eta1.Propo∞ddiagnosticcriteriafortheBrogadasyndrome:eonsonsu$report.Circulation,2002,106:2514-2519心率减速力测定心率减速力(decelerationcapacityofrate,DC)检测技术是德国慕尼黑心脏中心GeorgSchmidt教授近年发现并提出的一种检测自主神经张力的新技术。Schmidt教授也是窦性心率震荡(HeartRateTurbulence,HRT)技术的发现与提出者,这些成就使其迅速成为一位国际心电学领域脱颖而出的著名学者。瓤乙慨念与定义Ⅻ^人体窦性心率的快慢与高低受两方面因素的影响与调节:一是窦房结固有心率的影响,即窦房结本身自律性水平的高低,自律性高时心率快,低时心率慢;二是窦房结之外的多种因素的影响与调节,例如机体代谢率的高低、体温等都能引起心率的变化。这些诸多因素对心率产生影响的渠道和最后公路是自主神经及其介导的各种生理反射性调节,这一作用被形象地称为心率调节的“最后公路”。因此,窦性心率的快慢很大程度上是自主神经直接与反射性两种调节的结果。自主神经中的交感神经是心脏的加速神经,其兴奋性增加或张力增高时心率变快,心率加速力(accelerationcapacityofheartrate,AC)增强。相反,迷走神经是心脏的减速神经,其兴奋性增加时心率变慢,心率减速力增强。心率减速力的检测是通过24小时心率的整体趋向性分析和减速能力的测定,定量评估受检者迷走神经张力的高低,进而筛选和预警猝死高危患者的一种新的无创心电技术。减速力降.97.低提示迷走神经的兴奋性降低,相应之下,其对人体的保护性作用下降,使患者猝死的危险性增加,反之,心率减速力正常提示迷走神经对人体的保护性较强,受检者属于猝死的低危者。二检铡方法与技术检测技术分成以下几步:1动态心电图记录记录受检者全天“小时的动态心电图(图2-2-1)。2确定减速周期及加速周期并做标志(anchor)将24小时动态心电图经120Hz数字化自动处理系统转化为以心动周期RR值为纵坐标的序列图(图2-2...