动态心电图显示房室结双径路心电现象分析  

Analysis of electrocardiographic phenomena of dual atrioventricular nodal pathways revealed by dynamic electrocardiogram

作　　者：赵小平 朱正炎 曹冠红 刘燕 啜玉娟 赵勇 Zhao xiaoping;Zhu zhengyan;Cao guanhong;Liu yan;Chuai yujuan;Zhao yong(Beijing Shunyi District HosPital,Beijing,101300,China)

机构地区：[1]北京市顺义区医院,101300

出　　处：《临床心电学杂志》2021年第1期23-28,共6页Journal of Clinical Electrocardiology

摘　　要：目的探讨动态心电图揭示房室结双径路传导的心电图改变。方法回顾性分析11例动态心电图诊断房室结双径路患者的心电图特征和特殊心电现象。结果患者共11例,动态心电图均出现PR间期跳跃式延长,其中有4例表现为两种揭示房室结双径路存在的特征性心电现象:(1)房性早搏揭示房室结双径路7例。其中房性早搏的PR间期跳跃式延长诱发慢-快型房室结折返性心动过速(AVNRT)6例(其中有2例同时存在单次慢-快型房室结折返,即房性早搏的PR间期跳跃式延长后出现心房回波);房早的PR间期跳跃式延长并持续数个心搏,慢径路下传蝉联现象1例(此例亦同时存在另一种心电现象:长短固定两种PR间期,快-慢径路间传导的自发性转换);(2)不典型文氏型房室阻滞(AVB),PR间期跳跃式过度延长和PR间期跳跃式过度延长后慢径路下传蝉联现象,下传受阻的P波终止于慢径路前传1例;(3)不典型文氏型AVB,以心房回波终止文氏周期1例;(4)二度2:1房室阻滞,长短相间两种固定PR间期,下传受阻的P波后快-慢径路传导相互转换1例;(5)插入性室性早搏后PR间期跳跃式过度延长,慢径路下传蝉联现象形成房室传导的不典型反文氏1例。结论 PR间期跳跃式延长是房室结双径路存在的不可或缺的重要特征,认识上述特征性心电现象,有助于体表心电图诊断房室结双径路传导并减少误诊。Objective To investigate the changes of electrocardiogram(ECG) in dual pathway conduction of atrioventricular node(AVN) revealed by dynamic electrocardiogram(DCG). Methods The ECG characteristics and special ECG phenomena of 11 patients with dual atrioventricular node pathway diagnosed by dynamic ECG were retrospectively analyzed. Results In all the 11 patients, PR interval jumping prolongation occurred in dynamic electrocardiogram, and 4 of them showed two characteristic ECG phenomena which revealed the existence of dual atrioventricular node pathways.(1)Premature atrial beats revealed double atrioventricular nodal pathways in 7 cases.There were 6 cases of slow-fast atrioventricular nodal reflex tachycardia(AVNRT) induced by prolonged PR interval of atrial premature beats(two of them had single slow-fast atrioventricular nodal reflex, i.e. atrial echo appeared after prolonged PR interval of atrial premature beats);atrial premature beats prolonged PR interval of atrial premature beats and lasted several beats. There was one case of downward transmission of pathways(another ECG phenomenon was also present in this case: fixed PR interval of length and spontaneous transition of conduction between fast and slow pathways);(2) Atypical Ventricular Blockade(AVB), PR Interval Jumping Extension and PR Interval Jumping Extension followed by slow pathway downward transmission, and slow pathway forward transmission was terminated in1 case by blocked downward P wave;(3) Atypical ventricular block with Wenckebach cycle, and there was one patient’s Wenckebach cycle ended with an atrial echo;(4)Second degree 2:1 atrioventricular block, two fixed PR intervals between long and short phases, fast-slow pathway conduction after downward blocked P-wave in 1 case;(5)The PR interval jumping type was prolonged excessively after the insertion of premature ventricular beats, and the phenomenon of slow pathway downward transmission was associated with atypical antiventricular conduction in 1 case. Conclusions Jumping prolongation of PR in

关 键 词：房室结双径路 房室结折返性心动过速 蝉联现象 文氏现象 动态心电图 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]