不全潜在性房室旁路的电生理分析  

Electrophysiological analysis of incomplete potential accessory pathway

作　　者：徐海[1] 马晓华[1] 张启高[1] 徐云[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)心脏内科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2011年第11期1169-1172,共4页Journal of Medical Postgraduates

摘　　要：目的不全潜在性房室旁路是指旁路前传预激较小部分心肌,致使患者静息心电图相关指标在正常范围,但与射频消融术后比较仍可发现变化。文中旨在探讨这类患者的临床特点。方法回顾性分析近年来成功射频消融的单支房室旁路159例患者,将其分为3组:显性旁路组46例,不全潜在性旁路组32例,隐匿性旁路组81例。比较消融前后各组患者心电图参数的变化,以及旁路位置分布。结果消融前显性旁路组患者PR间期较不全潜在性旁路组及隐匿性旁路组患者缩短、QRS及QTc间期延长(P<0.001),但不全潜在性旁路组与隐匿性旁路组在PR、QRS及QTc间期方面比较差异无统计学意义。不全潜在性旁路组患者消融后PR间期较消融前延长,QRS间期较术前缩短,而QTc间期及心室率(heart rate,HR)消融前后无差异。显性旁路组患者的右侧旁路所占比例相对较大,而不全潜在性旁路组中的左侧旁路显著多于右侧。结论不全潜在性旁路在临床上并不少见,此类患者旁路多分布左侧,同时发作心动过速多为顺向型房室折返性心动过速。尽管消融术前心电图参数改变在正常范围,但将消融术前后的QRS波形向量比较仍有差异。] Objective Incomplete potential accessory pathway(IPAP) may make the resting electrocardiogram normal,but differences do exist after radiofrequency catheter ablation(RCA).The present study aims to investigate the clinical features of IPAP.Methods We retrospectively analyzed 159 cases of single accessory pathway treated successfully by RCA.The patients were divided into three groups: manifested pre-excitation(n=46),IPAP(n=32),and concealed accessory pathway(n=81).Comparisons were made in the electrocardiographic parameters of different groups before and after RCA,with analysis of the locations of accessory pathway.Results Before RCA,the PR intervals of the manifested pre-excitation group were shorter,while the QRS durations and QTc intervals were longer than those of the IPAP and concealed accessory pathway groups,with no significant differences in PR intervals,QRS durations and QTc intervals between the latter two groups.The IPAP group showed increased PR intervals,reduced QRS durations and similar QTc intervals and heart rate after RCA.The proportion of the right atrioventricular accessory pathway was relatively larger in the manifested pre-excitation group,and that of the left obviously higher in the IPAP group.Conlusion IPAP is not rare clinically,which is often located in the left atrioventricular accessory pathway,and tachycardia frequently occurs as orthodromic atrioventricular reentry tachycardia.Although the electrocardiographic parameters of these patients are normal before RCA,changes do occur in the vector of QRS after it.

关 键 词：不全潜在性旁路 射频消融 心电图 

分 类 号：R54[医药卫生—心血管疾病]