自发性早搏对房室结双径路传导的揭示作用  

Spontaneous premature beats reveal the dual atrioveentricular nodal pathways

作　　者：李兴杰 雷蕾 王军阳[3] Li xingjie;Lei lei;Wang junyang(First People’s Court of Jining City,Shandong,272011,China;Electrocardiography Room,First Affiliated Hospital of Shandong First Medical University,Shandong,250014,China;Electrocardiography Room,Tengzhou Central People’s Hospital,Shandong,277500,China)

机构地区：[1]山东省济宁市第一人民院,272011 [2]山东省第一医科大学第一附属医院,250014 [3]山东省滕州市中心人民医院,277500

出　　处：《临床心电学杂志》2021年第4期267-273,共7页Journal of Clinical Electrocardiology

摘　　要：目的探讨自发性早搏揭示房室结双径路传导现象的心电图特点及产生机理。方法以8例典型病例为资料进行分析、探讨。结果当患者心电图出现以下表现时,提示存在房室结双径路传导现象:(1)房早及室早时RP间期相近或相等,而PR间期短、长迥异;(2)房早或室早诱发(或终止)PR间期跳跃性延长或缩短并累及多次心搏(两径路间的蝉联现象):(3)短阵房速时出现不典型文氏现象,相同或相近RP时PR间期迥异;(4)室早或房早诱发1:2房室传导现象;(5)房室传导中的"矛盾"现象:与自发性早搏相关的PR间期和根据"RP/PR关系"预期的情况相悖;PR’间期短时形成室性融合波,PR’间期长时反而未形成;(6)房早诱发AVRT时,其频率快慢与诱发时P’R间期的短长相关。结论自发性早搏对揭示房室结双径路传导有与电生理检查有"异曲同工"之妙,具无创、安全、实用等优点。应引起临床及心电工作者的足够重视。Objective To investigate the electrocardiogram characteristics and mechanism of spontaneous premature contractions that reveal dual atrioveentricular nodal pathways(DAVNP). Methods The data of 8 typical cases were analyzed and discussed. Results The DAVNP were suggested when ECG showed the following manifestations:(1)RP interval was similar or equal between early atrioventricular and early atrioventricular, while PR interval was quite different;(2)early atrial or ventricular premature induced(or stopped) prolonged or shortened leap of PR interval and involved multiple beats(repeat between two paths);(3)Atypical Wenckbach phenomenon appeared in short atrial tachycardia, and PR interval was different in the same or similar RP;(4) Ventricular premature or atrial premature induces 1:2 atrioventricular conduction;(5)The "contradictory" phenomenon in atrioventricular conduction:a. The PR interval associated with spontaneous premature beats is contrary to the expectation based on the "RP/PR relationship";b. Sinusoventricular fusion wave appeared in the short PR’ interval, but did not appear in the long PR’interval;(6) The frequency of AVRT induced by atrial early onset was related to the short and long P’R interval.Conclusions Spontaneous premature beats have the same effect as electrophysiological examination in revealing DAVNP which is non-invasive, safe and practical.Should cause enough attention of clinic and electrocardiologist.

关 键 词：心电图 房室结双径路传导 1房室传导 蝉联现象 早搏 

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