右心室心尖部起搏时QRS波群与电张调整性T波的相关性研究

Investigation of relationship of QRS morphology during right ventricular apical pacing to electrotonic modulated T wave

目的探讨右心室心尖部起搏时QRS形态与心脏电张调整性T波的相关性。方法对35例右心室心尖部临时或永久性起搏患者起搏时QRS形态与恢复室上性心律时心脏电张调整性T波的分布特征及其相关性进行分析,并比较其同导联T/QRS比值。结果右心室心尖部起搏后电张调整性T波分布广,除下壁导联(Ⅱ、Ⅲ、aVF)外,胸导联亦广泛存在(V1～V4占100.0%,V1～V6占76.7%),倒置最深的T波常分布在V(4深度-0.71±0.27mV);心室起搏时最大负相QRS波群常出现在Ⅲ(深度-2.16±0.39mV);多数导联起搏时负相QRS波群深度与恢复室上性心律时同导联心脏电张调整性T波的深度呈正相关(r=0.3454～0.4804,P<0.05),T/QRS比值在胸导联(0.324±0.105～0.407±0.166)明显高于下壁导联(0.177±0.041～0.216±0.078,P<0.01)。结论右心室心尖部起搏时负相QRS波群深度与同导联心脏电张调整性T波的深度呈正相关,胸导联负相QRS波群所致电张调整性T波的深度约为下壁导联的2倍。

Objective To investigate relationship of QRS morphology during right ventricular apical pacing（RVAP） to electrotonic modulated T wave（EMTW）. Methods QRS pattern during RVAP and distribution of EMTW during supraventricular rhythm and their relationship were analyzed in 35 cases. Results After RVAP, EMTW appeared in inferior lead（ Ⅱ ,Ⅲ and aVF） and most of precordial lead （V1 to V4 100.0%,V5 91.4% and V6 77.1%） with deepest EMTW often in lead V4 （-0.71mV± 0.27mV）. The deepest negative QRS was usually seen in lead III （-2.16mV±0.39mV） during RVAP. Depth of negative QRS during RVAP in most leads was positively related to that of EMTW during supraventricular rhythm in same lead（r=-0.3454-0.4804, P〈0.05）. The ratio of depth of EMTW to that of negative QRS was higher in inferior lead than that in precordial lead （0.324±0.105-0.407±0.166 vs. 0.177±0.041-0.216±0.078, P〈0.01）. Conclusion The depth of negative QRS during RVAP was positively related to that of EMTW during supraventricular rhythm. The depth of EMTW in precordial lead is about twice that in inferior lead.