预激综合征心电图PJ间期分析

The influence of accessory pathway conduction on PJ interval in preexcitation syndrome

目的通过对比分析显性单旁路预激综合征导管射频消融（RFCA）术前、术后心电图，探讨预激综合征旁路前传对PJ间期的影响。方法选择RFCA治愈的显性单旁路预激综合征患者129例，根据旁路部位分为十组。分别测量各组RFCA术前、术后PR间期、QRS时间、PJ间期以及术前δ波时间。比较各组RFCA术前、术后PJ间期，术前正路传导时间（术前PR间期＋δ波时间）与术后PR间期，术前正路下传除极心室时间（术前QRS时间-δ波时间）与术后QRS时间，比较术前各组δ波时间。结果（1）右后壁组、右后间隔组术前PJ间期明显短于术后[右后壁组术前（226±18）ms，术后（236±19）ms，P〈0．01；右后间隔组术前（221±18）ms，术后（238±31）ms，P〈0．05]，其他各组PJ间期术前与术后比较差异均无统计学意义。（2）各组患者术前正路传导时间与术后PR间期比较，差异均无统计学意义。（3）右后壁组、右后间隔组术前正路下传除极心室时间明显短于术后QRS时间[右后壁组术前正路下传除极心室时间（79±12）ms，术后QRS时间（87±9）ms，P〈0．01）；右后间隔组术前正路下传除极心室时间（70±13）ms，术后QRS时间（86±9）ms，P〈0．05]，其他各组术前正路下传除极心室时间与术后QRS时间比较差异均无统计学意义。（4）右后壁组、右后间隔组δ波时间明显大于左后壁组和左后间隔组（P〈0．05）。结论预激综合征不仅不延长PJ间期，且可能缩短PJ间期，其主要取决于旁路心室端距离心室正常最后除极部位的远近及心室预激程度。

Objective To observe the influence of accessory pathway （AP） conduction on PJ interval in preexcitation syndrome patients. Methods One hundred and twenty-nine patients with dominant AP who underwent successful radiofrequency catheter ablation （RFCA） were included. Patients were divided into 10 groups according to AP location. The PR interval,QRS duration,PJ interval and delta wave duration were measured using simultaneous 12-lead electrocardiography before and after RFCA. The PJ interval before R^A were compared with that after RFCA. The atrioventricular （AV） conduction time via AV node-His conduction system before RFCA was compared with the PR interval after RFCA. The ventricular depolarization time via AV node-His conduction system before RFCA was compared with the QRS duration after RFCA. Delta wave duration was compared between two groups. Results （ 1 ）The PJ interval of fight posterior （RP） group and right postereseptal （R/S） group before RFCA were shorter than those after RFCA [RP group（226± 18） ms vs （236 ± 19 ） ms,P 〈 0.01 ,RPS group （221 ± 18） ms vs （238 ± 31 ） ms,P 〈 0.05 ]. （2）There were no significant differences between the AV conduction time via AV node-His conduction system before RFCA and the PR interval after RFCA. （3）The ventricular depolarization time via AV node-His conduction system of RP group and RPS group before RFCA was shorter than the PR interval after RFCA[RP group（79± 12） ms vs （87± 9） ms,P 〈 0.01 ;RPS group （70 ± 13） ms vs （86 ± 9） ms,P 〈 0.05 ]. （4）The delta wave duration of RP group and RPS group was longer than that of left posterior group and left posteroseptal group （P 〈 0.05）. Conclusion PJ interval is shortened by preexcitation syndrome. It is determined by AP location and the extent of preexcitation.