间歇性左束支阻滞时QRS波形态特点的分析

ECG characteristics of the intermittent complete left bundle branch block

目的观察12导联动态心电图间歇性完全性左束支阻滞出现前后心电图QRS波群形态改变特点。方法选择2005年1月至2009年3月住院的16158例患者的12导联动态心电图,检出间歇性完全性左束支阻滞16例,占0.9‰,并对完全性左束支阻滞时心电图QRS波群形态改变的特点进行分析。结果①平均QRS电轴:完全性左束支阻滞时33.64±59.77°,正常室内传导时68.36±13.70°,二者比较,p=0.038;②QT间期:完全性左束支阻滞时0.44±0.07s,正常室内传导时0.40±0.08s,二者比较,p<0.001;③V2导联r波振幅:完全性左束支阻滞时0.13±0.08mV,正常室内传导时0.41±0.28mV,p=0.02。结论间歇性完全性左束支阻滞发生率较低,心电图主要特点为QRS电轴左偏,QT间期延长,V2导联r波振幅明显降低或消失,QRS波群总振幅无明显改变,上述特点有助于识别动态心电图中的间歇性完全性左束支阻滞。

Objective To investigate the QRS changes of the patients with ECG manifested as intermittent complete left bundle branch block. Methods In the 16158 patients enrolled in our hospital from 2005.1-2009.3, there are 16 patients were found with intermittent complete left bundle branch block in their 12-lead Hoher monitoring, and we analysed the QRS changes in normal ECG and in the left bundle branch block. Results QRS axis is at 33.64 ± 59.77 in the intermittent left bundle branch block group, while in the normal ventricular conduction is 68.36 ± 13.70（p = 0.038）. QT interval is at 0.44 ± 0.07s in left bundle branch block group, while in the normal ventricular conduction group is at 0.40 ± 0.08s （p〈0.001）. V2 lead r-wave amplitude in the left bundle branch block group is at 0.13 ± 0.08mV and in normal ventricular conduction group goes to 0.41 ± 0.28mV （p = 0.02）. Conclusions In the intermittent left bundle branch block is a rare ECG manifestation in the 12-lead Hoher monitoring, QRS axis occurred in the left side, QT interval prolongation and V2 ECG r-wave amplitude are significantly decreased or disappeared compared to the normal ventricular conduction group. The features of these changes is help to find the intermittent complete left bundle branch block.