預(yù)激綜合征并束支或房室阻滯患者PJ間期分析

1、預(yù)激綜合征并束支或房室阻滯患者PJ間期分析         11-03-31 13:15:00     作者：劉仁光     編輯：studa20【摘要】  目的 分析預(yù)激綜合征并束支阻滯、房室阻滯對PJ間期的影響。方法 回顧分析12例典型預(yù)激綜合征并束支阻滯或房室阻滯患者有典型預(yù)激表現(xiàn)時和消除旁路傳導(dǎo)（消融旁路10例，間歇性2例）后心電圖：測量PR間期、QRS時間（形態(tài)）、PJ間期，分析旁路傳導(dǎo)和旁路部位對PJ間期的影響。結(jié)

2、果 （1）12例（并束支阻滯8例、一度房室阻滯4例），在消除旁路傳導(dǎo)后PJ間期均延長（0.280.36 s）。（2）旁路前傳（典型預(yù)激）時，12例PJ間期均較消除旁路傳導(dǎo)時有不同程度的縮短（縮短0.020.12 s）；一度房室阻滯4例縮短后的PJ間期仍0.26 s(0.280.30 s)；并束支阻滯則與旁路位置有關(guān)：旁路位束支阻滯同側(cè)（6例），PJ間期均縮至正常范圍（0.220.25 s），位異側(cè)1例縮為0.27 s，1例為0.25 s。結(jié)論 （1）預(yù)激綜合征旁路前傳可掩蓋房室阻滯和束支阻滯的心電圖表現(xiàn)，同時能不同程度的縮短延長的PJ間期：（2）預(yù)激綜合征PJ間期延長提示并房室阻滯或束支阻滯，

3、但PJ間期正常不能排除束支阻滯。 【關(guān)鍵詞】  預(yù)激綜合征 房室阻滯 束支阻滯 PJ間期   Abstract：Objective  This thesis aims to investigate the affected PJ intervals in patients with the preexcitation syndrome when combining with BBB or AVB. Methods  The manifestation of ECGs compared between the occurrence of the

4、typical preexcitation syndrome and the period after receiving ablation accessory pathway (AP) were retrospectively reviewed in 12 patients with preexcitation syndrome combining with BBB or AVB (10 individuals received ablation AP and 2 individuals with intermittent preexcitation). The PJ intervals i

5、nfluenced by the conduction and location of AP were investigated by measuring the duration of PR intervals, QRS complexes (morphologies) and PJ intervals. Results   (1) The duration of PJ intervals of all 12 patients (8 and 4 individuals in combination with BBB and the first degree AVB res

6、pectively) were prolonged after ablation AP (0.280.36 s). (2) When the typical preexcitation occurred, the duration of the PJ intervals of 12 patients after ablation AP were shortened to differential extents (0.020.12 s) and that of 4 patients remained more than 0.24 s after the shortened PJ interva

7、ls (0.280.30 s) in the first degree AVB. The preexcitation syndrome combining with BBB was concerned with the location of AP. The duration of PJ intervals was shortened to the normal range（0.220.25 s）when AP and BBB (6 individuals) were homolateral and 0.27 s (an individual) and 0.25 s (an individua

8、l) when they are antarafacial. Conclusions  (1) The preexcitation syndrome for descending by AP may mask the manifestation of BBB and AVB and simultaneously shorten the prolonged PJ intervals to variable extents. (2) The prolonged PJ intervals in patients with the preexcitation syndrome indicat

9、e its combination with AVB or BBB but we can not exclude the possibility of its combination with BBB if the duration of PJ interval is in the normal range.    Key words： preexcitation syndrome; bundle branch block ; atrial-ventricular block; PJ interval    PJ間期為PR間期與QRS

10、時間之和，PR間期延長（一度房室阻滯，AVB）和QRS時間增寬（束支阻滯，BBB）是引起PJ間期延長的主要原因。預(yù)激綜合征患者雖QRS時間增寬，但PR間期縮短，不延長PJ間期。當(dāng)預(yù)激綜合征并束支阻滯或房室阻滯時，旁路前傳對PJ間期有何影響尚不明確，為此我們選12例典型預(yù)激綜合征并束支阻滯或房室阻滯患者，對射頻消融旁路前、后（或間歇時），有旁路前傳和無旁路前傳的臨床心電圖資料對照分析討論如下。    1  臨床心電圖資料    病例選擇標(biāo)準(zhǔn)：（1）預(yù)激綜合征并束支阻滯：心電圖有典型預(yù)激綜合征表現(xiàn)，心動過速和消除旁路傳導(dǎo)后有同型

11、束支阻滯表現(xiàn)。（2）預(yù)激綜合征并一度房室阻滯：心電圖有典型預(yù)激綜合征表現(xiàn)，但PJ間期延長（0.27 s），心動過速時QRS正常，消除旁路傳導(dǎo)后PR間期延長符合一度AVB診斷標(biāo)準(zhǔn)。12例預(yù)激綜合征并BBB或AVB射頻消融旁路前、后（或間歇時）臨床心電圖資料詳見表1。表1  12例預(yù)激綜合征并束支或房室阻滯消融旁路前、后（或間歇時）臨床心電圖資料例號性別年齡旁路前傳PR間期QRS時間PJ間期消除旁路前傳PR間期QRS時間（波形）    2  分析與討論    2.1  本組12例（BBB 8例，一度AVB 4

12、例），在消除旁路傳導(dǎo)后PJ間期均延長（0.280.36 s）。一度房室阻滯PJ間期延長的程度與PR間期延長的程度有關(guān)；束支阻滯PJ間期延長的程度與QRS增寬的程度有關(guān)，同時受PR間期影響。    2.2  在顯示心室預(yù)激（旁路前傳）時，12例PJ間期均較消除旁路傳導(dǎo)時縮短（縮短0.020.12 s）。對一度房室阻滯旁路前傳雖能縮短延長的PJ間期，但PJ間期均大于正常范圍（為0.280.30 s），見圖1(例11)；束支阻滯則與旁路位置有關(guān)：旁路位束支阻滯同側(cè)6例，PJ間期均縮至正常范圍（為0.220.25 s）；位異側(cè)2例，1例PJ間期縮至正常范圍（0.25 s，見圖2例8），另1例縮至0.27 s。    左圖為消融旁路前心電圖：示B型預(yù)激綜合征，PJ間期0.30 s；中圖為誘發(fā)房室折返性心動過速心電圖：QRS轉(zhuǎn)