预激综合征δ波时间与PR间期及QRS时间变化相关性的研究

The Relationship Between Delta Waves and the Changes of PR Intervals and QRS Durations in Preexcitation Syndrome

目的:通过观测不完全预激时δ波时间与PR间期、QRS时间变化的相关关系,得出显性预激综合征判断房室结传导时间的方法。方法:选经导管射频消融术(radiofrequency catheter ablation,RFCA)治愈的显性预激综合征患者129例,据旁路部位分10组:左前壁(LA)、左侧壁(LL)、左后壁(LP)、左后间隔(LPS)、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);测定δ波时间,术前、术后PR间期及ORS时间,计算其变化值(ΔPR、ΔQRS);δ波时间与ΔPR、ΔQRS相关分析采用直线相关分析,δ波时间与ΔPR、ΔQRS比较采用配对t检验,并用等效检验进行验证。结果:①10组显性预激综合征δ波时间与ΔPR均呈高度相关(P<0.01);②右后壁、右后间隔、左后间隔旁路δ波时间与ΔQRS无相关关系(分别为r=0.412,P>0.05和r=0.202,P>0.05,r=-0.125,P>0.05),其他各组均呈直线相关。③δ波时间分别与ΔPR比较各组均无显著差异(P>0.05);④右后壁、右后间隔组δ波时间与ΔQRS比较差异显著(右后间隔P<0.05,右后侧P<0.01),其他部位旁路组无显著差异。结论:不完全预激时,δ波时间与消融前后PR缩短值无明显差异,P波起始至δ波终点(δ波与QRS交点处)的时间等于术后PR间期,以此可判断显性不完全预激综合征经房室结通路下传激动到心室的时间,为临床射频消融术前体表心电图判断预激综合征房室结功能提供理论依据。

Objective： To observe the relationship between delta waves and the changes of PR intervals and QRS durations in preexcitation syndrome. Methods： 129 patients with a single dominant preexcitation syndrome who underwent successful radiofrequency ablation （RFCA） were included. Patients were divided into 10 groups according to lesion＇ s location：left anterolateral （LA） group （n = 28）, left lateral （LL） group （n = 28）, left posterior （LP） group （ n = 13）, left posteroseptal （LPS） group （ n = 9）, right anterolateral （RA） group （ n = 6 ）, right lateral （RL） group （ n = 9）, right posterior （RP） group （ n = 16）, right anteroseptal （RAS） group （ n = 5）, right midseptal （RMS） group （ n = 7） and right posteroseptal （RPS） group （ n = 8）. The PR intervals, QRS durations and delta waves were measured using simultaneous 12 - lead ECG before and after ablation. The changes of PR intervals before and after RFCA （△PR）, the changes of QRS durations before and after RFCA （ △ QRS） were detected. Results：① The delta waves was significantly correlated with △ PR in 10 groups（ P 〈 0.01）. ②There was no significant correlation between delta waves and △QRS in right posterior group, right posteroseptal group and left posteroseptal group （r = 0.412, P 〉 0.05, r = 0. 202, P 〉 0.05, r = - 0.125, P 〉 0.05, respectively）. ③There was no significant difference between delta waves and ApR （P 〉 0.05） in 10 groups. ④There was significantly different between delta waves and △QRS in right posterior group and right posteroseptal group. The delta waves and △QRS had no significant difference in othere groups. Conclusion：Duration from the beginning of P wave to the end of delta wave before ablationis equal to PR interval after ablation. The atrioventricular conduction time via atrioventricular node - His conduction system before ablation can be evaluated by measuring the duration from the beginning of P wave to the end of delta wave. It is a easy and convenient method to evaluate atrioventricular conduction time.