预激综合征旁路前传可能缩短PJ间期

Prograde conduction of the pathway in pre-excitation syndrome may shorten PJ interval

目的探讨预激综合征旁路前传能否缩短PJ间期及预激综合征PJ间期延长的临床意义。方法选择导管射频消融根治的显性单旁路预激综合征143例，按房室结前传经路（正路）有无房室和束支阻滞分为A，B两组。A组为正常组132例（按旁路部位进一步分10个亚组），B组为并Ⅰ度房室阻滞或束支阻滞组11例。各组分别对照分析有无旁路传导心电图。结果（1）A组右后和右后间隔亚组PJ间期较消融旁路后缩短，差异有统计学意义[分别为（226±18）msvs（236±19）ms和（221±18）msvs（238±31）ms，均P〈0．05]。（2）B组11例旁路前传均不同程度缩短正路阻滞引起延长的PJ间期：Ⅰ度房室阻滞（4例），PJ间期虽缩短但仍大于正常范围；束支阻滞（7例），有4例PJ间期缩短到正常范围。结论预激综合征在正路传导正常时，旁路前传不延长PJ间期，且可能缩短PJ间期；在正路传导异常时旁路前传能缩短延长的PJ间期；预激综合征PJ间期延长提示并房室或束支阻滞，但PJ间期正常不能排除并束支阻滞。

Objective To investigate whether the PJ interval in the patients with pre-excitation syndrome can be shortened by pathway conduction, and to explore the clinical implications of the prolonged PJ interval. Methods 143 patients with single pathway, who experienced successful radiofrequency （RF） ablation, were divided into two groups： Group A （n = 132） with normal atrioventr/cular and ventricular conduction （ sub-divided into 10 subsets further according to the location of the pathway） and Group B （ n = 11 ） with first degreeatrioventricular block or with bundle branch block. The ECG images with and without pathway conduction were analyzed. Results （ 1 ） The PJ interval in the patients with right posterior pathway or with right septal pathway was shortened significantly after the RF [ （226 ± 18） ms vs（236 ± 19） ms and （221± 18）ms vs（238 ±31）ms respectively,both P〈0. 05] ;（2） The PJ interval in Group B was shortened to different extents. The PJ interval values in 4 patients with first degree atrioventricular block were shortened, but still beyond normal extent. The PJ interval values in 4 patients with bundle branch block were shorted to normal extent. Conclusion If the pre-excitation syndrome patients have normal atrioventricular conduction the PJ interval is normal or the PJ interval may be shortened. If the patients have prolonged atrioventricular conduction, the PJ interval may be shortened by the pathway prograde conduction. PJ interval prolongation indicates atrioventricular conduction delay or ventricular conduction block, but bundle branch block cannot be excluded when the PJ interval is normal.