预激综合征对QRS波终末向量的影响

Effect of Preexcitation Syndrome on QRS Complex Terminal Vector.

为探讨预激综合征对QRS波终末向量的影响和终末向量改变的临床意义 ,选择经射频消融 (RFCA)术治愈的显性预激综合征患者 12 9例 ,据旁道部位分 9组 :左前壁 (LA)、左侧壁 (LL)、左后壁 (LP)、右前壁 (RA)、右侧壁(RL)、右后壁 (RP)、右前间隔 (RAS)、右中间隔 (RMS)、右后间隔 (RPS) ,对比分析RFCA术前、后心电图。结果 :①与消融旁道后心电图对比 ,12 9例显性预激综合征均影响终末向量。②终末向量改变与旁道位置有关 :aVL(和Ⅰ )导联 :终末负向波振幅增加 ,或终末正向波变为负向波主要出现在LA、LL旁道 ;终末正向波振幅增加 ,或负向波振幅减小或变为正向波主要出现在LP、RA、RL、RP、RAS、RMS、RPS旁道。Ⅲ (和aVF)导联 :终末正向波振幅增加 ,或负向波变为正向波 ,或终末无变化主要出现在LA、LL、RA、RAS旁道 ;终末正向波变为负向波 ,或正向波振幅减小 ,或负向波振幅增加主要出现在LP、RL、RP、RMS、RPS旁道。V1导联 :终末负向波振幅减小或消失主要出现在LA、LL、LP旁道 ;终末负向波振幅增加主要出现在RA、RL、RP、RAS、RMS、RPS旁道。③终末向量改变与预激波有关 :aVL、Ⅰ、Ⅱ、aVF、Ⅲ、V1导联QRS波终末向量的变化与预激向量方向基本一致 (P <0 .0 1)。结论

To investigate the effect of preexcitation syndrome on QRS complex terminal vector and its clinical significance, 129 patients with preexcitation syndrome were confirmed to be single accessory pathway(AP)by radiofrequency catheter ablation(RFCA) and divided into 9 groups according to AP site: left anterior wall(LA), left lateral wall (LL), left posterior wall (LP), right anterior wall (RA), right lateral wall (RL), right posterior wall (RP), right anterior septal(RAS), right middle septal (RMS), right posterior septal (RPS). The terminal vector of QRS complex before and after RFCA were analyzed. Results:①The terminal vector changed before RFCA compared with that after RFCA in all patients.②The characteristics of the QRS complex terminal vector depended upon sites of AP: AP in LA, LL had the changes of QRS terminal vector that demonstrated the negative wave got deepen,or the positive wave changed into negative wave in leads aVL,Ⅰ. AP in LP, RA, RL, RP, RAS, RMS, RPS demonstrated that the negative wave got shallow, or the negative wave changed into positive wave, or the positive wave got deepen in leads aVL,Ⅰ. AP in LA, LL, RA, RAS demonstrated that the positive wave got deepen, or the negative wave changed into positive wave in leads Ⅲ, aVF. AP in LP, RL, RP, RMS, RPS demonstrated that the positive wave got shallow, or the negative wave got deepen, or the positive wave changed into negative wave in leads Ⅲ, aVF. AP in LA, LL, LP had the changes of the QRS terminal vector that demonstrated the negative wave got shallow, disappeared in lead V 1. AP in RA, RL, RP, RAS, RMS, RPS demonstrated that the negative wave got deepen in lead V 1. ③The changing trend of the QRS complex terminal vector was concordant with the initial vector polarity in leads aVL, Ⅰ, Ⅱ, aVF, Ⅲ and V 1( P <0.01). Conclusions: The changes of the QRS complex terminal vector might be helpful to the diagnosis and localization of AP in preexcitation syndrome without obvious delta wave.