预激综合征射频消融术后心电图电张调整性T波及J-ST段特征分析  

Characteristics of electrotonic modulated T wave and J-ST segment after radiofrequency ablation in patients of preexcitation syndrome

作　　者：李健豪[1] 宋明才[1] 杨平珍[2] 吴书林[2] 

机构地区：[1]广州市番禺区人民医院心内科,广东广州511400 [2]广东省人民医院心内科

出　　处：《中国心脏起搏与心电生理杂志》2008年第1期50-53,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨预激综合征射频消融房室旁道后心电图出现电张调整性T波及J-ST段的特征及其发生机制。方法45例持续性预激综合征患者,对比射频消融术前后心电图,总结和分析术后电张调整性T波、J波以及ST段变化的发生规律和特征。结果45例中射频消融术后出现电张调整性T波改变有27例,间隔部和左前壁旁道消融后电张调整性T波出现率最高(达100%),电张调整性T波主要分布于下壁导联(Ⅱ、Ⅲ、aVF)和高侧壁导联(Ⅰ、aVL);下壁导联电张调整性T波倒置深度Ⅲ>aVF>Ⅱ(P<0.01),高侧壁导联aVL>Ⅰ。此外尚可出现J-ST改变,表现为J点抬高、J波和ST段水平或弓背向下型抬高,总发生率高于同期隐匿性旁道消融组(42.2%vs3.5%,P<0.01)。结论预激综合征射频消融术后电张调整性T波的出现取决于预激时QRS波形态;射频消融术后心电图可出现类似早期复极综合征的J-ST段改变。Objective To investigate characteristics of electrotonic modulated T wave and the J-ST segment in ECG in patients with preexcitation syndrome after radiofrequency ablation（RFCA）. Method Characteristics of electrotonic modulated T wave and the J-ST segment in ECG were analyzed before and after RFCA in 45 cases who had preexcitation syndrome. Results ①Electrotonic modulated T wave was detected in 27 of the 45 cases （ 60% ） , all cases （ 15 cases, 100% ）with accessory pathway（AP） in septum or left anterior free wall presented modulated T wave after successful ablation ; ②In spite of the location of AP, electrotonic modulated T wave was mainly found in inferior wall leads （Ⅱ , Ⅲ, and aVF） and high lateral wall leads（ Ⅰ , aVL）. Amplitude of electrotonic modulated T wave was Ⅲ 〉 aVF 〉 Ⅱ （ P 〈 0.01 ） in inferior wall leads and aVL 〉 Ⅰ in high lateral wall leads. ③After ablation, elevation of J point, J wave and ST segment could be found in ECG, this characteristics were significantly higher in preexcitation syndrome group than in the recessive AP group（42.2% vs 3.5% ,P 〈 0.01 ）. Conclusions Appearance of electrotonic modulated T wave in ECG after RF- CA depends on the location of AP which results in different QRS complex. Furthermore, changs of J-ST segment is similar to early repolarization syndrome.

关 键 词：心血管病学 预激综合征 导管消融 射频电流 电张调整性T波 J波 早期复极综合征 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]