经食管电生理检查中的交替文氏现象

Alternating Wenckebach Phenomenon in Transesophageal Electrophysiological Examination

在５６１例经食管电生理检查中，检出各类交替文氏现象（ＡＷ）８１例，共１３７例次，占１４．４％，其中Ａ型、Ｂ型、ＡＢ混合型、三层房室ＡＷ分别为４４，６０，１８，６例次，分别占３２．１％、４３．８％、１３．１％、４．４％；房室结双径路间、束支、房室旁束的ＡＷ分别为５，２，２例次，分别占３．６％、１．５％、１．５％。将７９例ＡＷ者（Ａ组）与８０例无ＡＷ者（Ｂ组）的电生理资料进行比较，显示：①窦性心率（ＳＲ），Ａ组较Ｂ组慢（７２±１４．２ｂｐｍｖｓ７８±１２．６ｂｐｍ，Ｐ＜０．００１）。②房室相对不应期（ＡＶＲＲＰ）、房室功能不应期（ＡＶＦＲＰ）、房室有效不应期（ＡＶＥＲＰ），Ａ组分别为６０９．０±１１９．４，４９６．６±９６．０，３６０．０±８８．０ｍｓ，与Ｂ组（５４６．０±６８．９，４２９．３±６１．５，３０７．０±５１．３ｍｓ）比较差异有高度显著性，Ｐ均＜０．００１。③心房有效不应期（ＡＥＲＰ），Ａ组与Ｂ组比较无显著差异（２６５．０±４２．３ｍｓｖｓ２６５．０±３７．３ｍｓ，Ｐ＞０．０５）。④随Ｓ１Ｓ１刺激间距缩短，Ａ组的房室传导顺序为：１１→文氏型→２１→交替文氏型→３１或心房Ｐ波脱漏；Ｂ组的房室传导顺序则?

A total of 81 cases,137 episodes (14.4%) with various types alternating Wenchebach phenomenon (AW) were found in 561 cases with transesophageal electrophysiological examination.44 times (32.1%),60 times (43.8%),18 times (13.1%) and 6 times (4.4%),18 times(13.1%) and 6 times (4.4%) of them were AW of type A,B,AB mix and three levels AV,respectively.The AW of between dual AV nodal pathways,bundle branches and kent bundle were 5 times (3.6%),2 times (1.5%) and 2 times (1.5%),respectively.The mean of electrophysiology was compared between 79 cases with AW (group A) and 80 cases without AW (group B).Results:sinus heart rate (SHR) in group A had significantly slower than group B(72±14.2 bpm vs 78±12 bpm, P < 0.001 ).Atrioventricular relative refractory period (AVRRP),atrioventricular function refractory peroid (AVFRP),atrioventricular effective refractory peroid (AVERP) in group A had significantly longer than group B,respectively (609.0±119.4 ms,496.6±96 ms,360.0±88.0 ms vs 546.0±68.9 ms,429.3±61.5 ms,307.0±51.3 ms, P <0.001).Along with the shorten of the S 1S 1 pacing cycle length,the AV conduction sequence of group A was 1∶1→Wenckebachs types→2∶1 AW→ 3∶1 or P wave with atrial disappear,but one of group B were 1∶1→Wenckebachs types→2∶1→3∶1 or P wave with atrial disappear.The results suggest that most of the AW are functional disorder.The level of pathologic changes of AW is intermediated between 2∶1 and 3∶1 conduction block.The clinical significance of AW should be analysed according to basic heart situation,basic heart rates,occurrence site and continued time of AW,and so on.