预激综合征并束支或房室阻滞患者PJ间期分析

The Investigation of the PJ Intervals in Patients with the Preexcitation Syndrome Combining with AVB or BBB

目的分析预激综合征并束支阻滞、房室阻滞对PJ间期的影响。方法回顾分析12例典型预激综合征并束支阻滞或旁室阻滞患者有典型预激表现时和消除旁路传导(消融旁路10例,间歇性2例)后心电图:测量PR间期、QRS时间(形态)、PJ间期,分析旁路传导和旁路部位对PJ间期的影响。结果(1)12例(并束支阻滞8例、一度房室阻滞4例),在消除旁路传导后PJ间期均延长(0.28～0.36s)。(2)旁路前传(典型预激)时,12例PJ间期均较消除旁路传导时有不同程度的缩短(缩短0.02～0.12s);一度房室阻滞4例缩短后的PJ间期仍>0.26s(0.28～0.30s);并束支阻滞则与旁路位置有关:旁路位束支阻滞同侧(6例),PJ间期均缩至正常范围(0.22～0.25s),位异侧1例缩为0.27s,1例为0.25s。结论(1)预激综合征旁路前传可掩盖房室阻滞和束支阻滞的心电图表现,同时能不同程度的缩短延长的PJ间期:(2)预激综合征PJ间期延长提示并房室阻滞或束支阻滞,但PJ间期正常不能排除束支阻滞。

Objective This thesis aims to investigate the affected PJ intervals in patients with the preexcitation syndrome when combining with BBB or AVB. Methods The manifestation of ECGs compared between the occurrence of the typical preexcitation syn- drome and the period after receiving ablation accessory pathway （AP） were retrospectively reviewed in 12 patients with preexcitation syndrome combining with BBB or AVB （ 10 individuals received ablation AP and 2 individuals with intermittent preexcitation）. The PJ intervals influenced by the conduction and location of AP were investigated by measuring the duration of PR intervals, QRS complexes （morphologies） and PJ intervals. Results （ 1 ） The duration of PJ intervals of all 12 patients （ 8 and 4 individuals in combination with BBB and the first degree AVB respectively） were prolonged after ablation AP （0.28 -0. 36 s） . （2） When the typical preexcitation occurred, the duration of the PJ intervals of 12 patients after ablation AP were shortened to differential extents （0. 02 -0. 12 s） and that of 4 patients remained more than 0. 24 s after the shortened PJ intervals （0. 28 -0. 30 s） in the first degree AVB. The preexcitation syndrome combining with BBB was concerned with the location of AP. The duration of PJ intervals was shortened to the normal range （0. 22 -0.25 s） when AP and BBB （6 individuals） were homolateral and 0. 27 s （an individual） and 0. 25 s （an individual） when they are antarafacial. Conclusions （ 1 ） The preexcitation syndrome for descending by AP may mask the manifestation of BBB and AVB and simultaneously shorten the prolonged PJ intervals to variable extents. （2） The prolonged PJ intervals in patients with the preexcitation syndrome indicate its combination with AVB or BBB but we can not exclude the possibility of its combination with BBB if the duration of PJ interval is in the normal range.