B型预激综合征左后间隔旁道的体表心电图特征及射频消融的体会

Character of surface electrocardiogram(ECG) for left posterior septal atrioventricular accessory pathway in type B Wolff-Parkinson-White(WPW) syndrome and experience of radiofrequency catheter ablation

目的提高体表心电图对显性房室旁道定位的准确性及射频消融术的治疗疗效。方法回顾性分析了53例B型预激综合征经过手术证实为左后间隔房室旁道的体表12导联同步心电图特征,并与162例B型预激综合征经过手术证实为右后间隔房室旁道体表12导联同步心电图进行比较。12导联心电图均采用GE Marquette Cardiosoft V4.11心电图机进行采集。结果B型预激综合征左后间隔与右后间隔房室旁道V1δ波方向、P-R间期、胸导联的移行区、Ⅱ、Ⅲ、avF导联Q/R之比以及V1导联QRS波的形态存在显著差别,而Ⅱ、Ⅲ、avF导联δ波的方向相同。结论在其他条件符合后间隔房室旁道的情况下,预激充分时V1导联QRS波呈Qr型,房室旁道为左后间隔,V1导联QRS波呈QS型时,房室旁道为右后间隔;预激不充分时V1导联呈rs或rS型时,V1导联P-R间期大于或等于110ms为左后间隔旁道,V1导联P-R间期小于或等于80ms右后间隔旁道。

Objective To increase the precise localization of dominance accessory atrioventricular pathways（AP） in surface ECG and the effect of radio frequency ablation. Methods ECG of 53 cases of left posterior septal of type B WPW syndrome which were confirmed from catheter ablation were analyzed. These 53 cases were compared with 161 cases of right posterior septal of type B WPW syndrome which were confirmed from catheter ablation. Results There were significant differences between left and right posterior septal AP, such as the direction of V1 lead delta wave, P-R interval, transitional zones of precordial leads, Q/R ratio of Ⅱ , Ⅲ ,avF leads and the shape of QRS complex. The delta wave direction of Ⅱ ,Ⅲ , avF leads were the same. Conclusion Among all the APs of posterior interval,when sufficient pre-excitation Qr in V1 indicate left posterior septal; QS in V1 indicate right posterior septal. When insufficient pre-excitation rs or rS in V1 ,P-R interval ≥1l0ms indicate left posterior septal; P-R interval≤80ms indicate right posterior septal.