Abstract: Background　 The ECG Lorenz scatter plot has been extensively reported to be used for studying the mechanism of qualitative diagnosis of various types of arrhythmia. However，there is no evidence on its use in the diagnosis of muscle sleeve atrial arrhythmias（AAR）. Objective　To analyze the characteristics of ECG Lorenz scatter plot of muscle sleeve AAR，providing evidence for rapid interpretation of this kind of ambulatory ECG. Methods　Participants were outpatients and inpatients retrospectively recruited from the Fifth Affiliated Hospital of Zhengzhou University from August 2016 to August 2020，including 31 with muscle sleeve AAR，and 30 with frequent non-muscle sleeve AAR，suggested by the ambulatory ECG Lorenz scatter plot. The features of the ambulatory ECG Lorenz scatter plot of two groups and inter-group differences were analyzed. Results　The overall features of the ambulatory ECG Lorenz scatter plot of 31 cases of muscle sleeve AAR were like this：（1）sinus rhythm with frequent atrial premature of a short coupling interval（part not delivered to ventricular）；（2） repeatedly paroxysmal atrial tachycardia（irregularly delivered to ventricular）；（3）repeatedly paroxysmal atrial flutter and atrial fibrillation constitute a scatter plot combination，embedding in diffusely scattered peripheral and distal sinus rhythms. The ECG Lorenz scatter plot of non-muscle sleeve AAR cases also had the first three same features of that of muscle sleeve AAR cases，mainly manifested as sinus rhythm combined with at least two other features，with a centralized distribution，instead of embedding in diffusely scattered peripheral and distal sinus rhythms. Conclusion　If an ECG Lorenz scatter plot shows the characteristics of sinus rhythm with multiple types of recurrent atrial arrhythmias embedded in the diffuse scattered background，then muscle sleeve AAR is highly suggested. According to this feature，muscle sleeve AAR could be quickly identified.

Key words: Arrhythmias, cardiac；Muscle sleeve atrial arrhythmias；Lorenz ECG scatter diagram；Dynamic electrocardiogram；Atrial premature of a short coupling interval；Repeatedly paroxysmal atrial flutter, atrial fibrillation

摘要： 背景　通过Lorenz心电散点图定性诊断各类心律失常发生机制的研究较多，但是对于肌袖性房性心律失常（AAR）患者的Lorenz心电散点图特征研究尚是空白。目的　探讨肌袖性AAR的Lorenz心电散点图特征，为快速分析此类Lorenz心电散点图奠定基础。方法　对2016年8月至2020年8月郑州大学第五附属医院门诊及住院患者Lorenz心电散点图中符合肌袖性AAR特点的31例患者Lorenz心电散点图进行回顾性分析，另选择30例DCG符合频发非肌袖性AAR特点的患者Lorenz心电散点图为对照组，分析总结其Lorenz心电散点图特征及两组间的差别。结果　31例肌袖性AAR患者Lorenz心电散点图总体特征是窦性心律+频发短联律间期房性期前收缩（部分房性期前收缩未下传心室）+反复发作性短阵房性心动过速（不规则下传）+反复发作性短阵心房扑动/心房颤动构成的Lorenz心电散点图组合，且其组合镶嵌在弥散性分布的散点背景当中；30例非肌袖性AAR患者Lorenz心电散点图是窦性心律可与频发房性期前收缩（部分未下传心室）、短阵房性心动过速、阵发性心房扑动/心房颤动中的两项或多项进行Lorenz心电散点图组合，但散点分布集中，未镶嵌在弥散性分布的散点背景当中。结论　Lorenz心电散点图若符合窦性心律+反复发作的多种房性心律失常构成的Lorenz心电散点图组合镶嵌在弥散性分布的散点背景当中的特征，高度提示肌袖性AAR，此特征可用于快速识别肌袖性AAR。

关键词: 心律失常, 肌袖性房性心律失常, Lorenz心电散点图, 动态心电图, 短联律间期房性期前收缩, 短阵性心房扑动/颤动