预激综合征并束支或房室阻滞患者PJ间期分析

1、预激综合征并束支或房室阻滞患者PJ间期分析         11-03-31 13:15:00     作者：刘仁光     编辑：studa20【摘要】  目的 分析预激综合征并束支阻滞、房室阻滞对PJ间期的影响。方法 回顾分析12例典型预激综合征并束支阻滞或房室阻滞患者有典型预激表现时和消除旁路传导（消融旁路10例，间歇性2例）后心电图：测量PR间期、QRS时间（形态）、PJ间期，分析旁路传导和旁路部位对PJ间期的影响。结

2、果 （1）12例（并束支阻滞8例、一度房室阻滞4例），在消除旁路传导后PJ间期均延长（0.280.36 s）。（2）旁路前传（典型预激）时，12例PJ间期均较消除旁路传导时有不同程度的缩短（缩短0.020.12 s）；一度房室阻滞4例缩短后的PJ间期仍0.26 s(0.280.30 s)；并束支阻滞则与旁路位置有关：旁路位束支阻滞同侧（6例），PJ间期均缩至正常范围（0.220.25 s），位异侧1例缩为0.27 s，1例为0.25 s。结论 （1）预激综合征旁路前传可掩盖房室阻滞和束支阻滞的心电图表现，同时能不同程度的缩短延长的PJ间期：（2）预激综合征PJ间期延长提示并房室阻滞或束支阻滞，

3、但PJ间期正常不能排除束支阻滞。 【关键词】  预激综合征 房室阻滞 束支阻滞 PJ间期   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间期为PR间期与QRS

10、时间之和，PR间期延长（一度房室阻滞，AVB）和QRS时间增宽（束支阻滞，BBB）是引起PJ间期延长的主要原因。预激综合征患者虽QRS时间增宽，但PR间期缩短，不延长PJ间期。当预激综合征并束支阻滞或房室阻滞时，旁路前传对PJ间期有何影响尚不明确，为此我们选12例典型预激综合征并束支阻滞或房室阻滞患者，对射频消融旁路前、后（或间歇时），有旁路前传和无旁路前传的临床心电图资料对照分析讨论如下。    1  临床心电图资料    病例选择标准：（1）预激综合征并束支阻滞：心电图有典型预激综合征表现，心动过速和消除旁路传导后有同型

11、束支阻滞表现。（2）预激综合征并一度房室阻滞：心电图有典型预激综合征表现，但PJ间期延长（0.27 s），心动过速时QRS正常，消除旁路传导后PR间期延长符合一度AVB诊断标准。12例预激综合征并BBB或AVB射频消融旁路前、后（或间歇时）临床心电图资料详见表1。表1  12例预激综合征并束支或房室阻滞消融旁路前、后（或间歇时）临床心电图资料例号性别年龄旁路前传PR间期QRS时间PJ间期消除旁路前传PR间期QRS时间（波形）    2  分析与讨论    2.1  本组12例（BBB 8例，一度AVB 4

12、例），在消除旁路传导后PJ间期均延长（0.280.36 s）。一度房室阻滞PJ间期延长的程度与PR间期延长的程度有关；束支阻滞PJ间期延长的程度与QRS增宽的程度有关，同时受PR间期影响。    2.2  在显示心室预激（旁路前传）时，12例PJ间期均较消除旁路传导时缩短（缩短0.020.12 s）。对一度房室阻滞旁路前传虽能缩短延长的PJ间期，但PJ间期均大于正常范围（为0.280.30 s），见图1(例11)；束支阻滞则与旁路位置有关：旁路位束支阻滞同侧6例，PJ间期均缩至正常范围（为0.220.25 s）；位异侧2例，1例PJ间期缩至正常范围（0.25 s，见图2例8），另1例缩至0.27 s。    左图为消融旁路前心电图：示B型预激综合征，PJ间期0.30 s；中图为诱发房室折返性心动过速心电图：QRS转