峡部依赖性心房扑动不典型心电图分析  

The analysis of atypical electrocardiogram in patients with isthmus-dependent atrial flutter

作　　者：闫素华[1] 程文娟[1] 陈明友[1] 孙洁[1] 徐希云[1] 

机构地区：[1]山东省千佛山医院心内科,250014

出　　处：《中华心律失常学杂志》2008年第2期95-98,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：山东省科技攻关项目（2005GG3202065）

摘　　要：目的分析峡部依赖性心房扑动（AFL）不典型心电图的特点及其形成机制。方法分析峡部依赖性AFL患者体表心电图扑动波（FL波）形态，并通过心内电生理检查观察冠状静脉窦（CS）传导顺序及传导时间等。结果根据下壁导联FL波形态，逆钟向传导AFL分为4组，组1负向FL波，组2负向FL波为主，终末端为正向，CS传导顺序均为近端至远端，传导时间分别为（33．41±13．43）ms、（35．23±15．56）ms；组3正向FL波为主，CS传导为远端至近端或融合传导，时间为（-21．3±11．41）ms；组4FL波为等电位波或低振幅波，CS传导为近端至远端。顺钟向传导AFL分为3组，组1为正向FL波，CS传导为融合传导或近端至远端，时间为（5．43±17．59）ms；组2为负向FL波，CS传导为近端至远端；组3FL波为等电位波或低振幅波，CS传导为融合传导。结论峡部依赖性AFL体表心电图下壁导联FL波形态与左心房除极顺序有关，而左心房除极顺序取决于心房间的传导连接部位，心房间传导连接的传导延迟或阻滞，可导致其体表心电图出现不典型的FL波形态。Objective To investigate the characteristics and mechanism of atypical electrocardiogram （ECG） in isthmus-dependent atrial flutter （AFL）. Methods Fifty-five patients with isthmus-dependent AFL underwent electrophysiological studies, patterns and activation times of coronary sinus （CS）and their relationship with the FL wave in the surface ECG were analyzed. Results According to FL wave morphology in inferior leads （ Ⅱ , Ⅲ ,aVF）, four groups of counterclockwise conduction AFL （CCW AFL） were observed： group 1 had purely negative FL wave in inferior leads; group 2 had small positive terminal portion with proximal-to-distal （PD） pattern. The CS activation direction of group 1 and 2 both were PD, and the activation time were （33.41 ± 13.43 ） ms and （ 35.23 ± 15.56 ） ms respectively. Group 3 had broad positive terminal portion or purely positive FL wave with a distal-to-proximal pattern （DP） or fused pattern （FL）, the activation time was （ -21.3 ± 11.41 ）ms. Group 4 had almost flat-line recording with PD pattern. Three groups of clockwise conduction AFL （ CW AFL） were observed ： group 1 had positive or notched positive F wave inferiorly with a PD or FL pattern in CS, the activation time was （5.43 ± 17. 59 ）ms. Group 2 had negative FL wave with PD pattern, the activation time was （42. 43 ± 14.41 ） ms. Group 3 had almost flat-line recording with fused pattern. Conclusions FL wave morphology in inferior leads of isthmus-dependent AFL is determined by the left atrium activation sequence, which is determined by the interatrial connections. The activation blockage or delay of the interatrial connections may change the FL wave morphology and induce atypical ECG appearance in isthmus-dependent AFL.

关 键 词：心房扑动 不典型心电图 电生理 

分 类 号：R541.7[医药卫生—心血管疾病]