隐匿型预激综合征心脏电生理的研究

Cardiac Electrophysiologic Investigation of Latent WPW Syndrome

本文对8例隐匿型预激综合征的患者进行了电生理的研究。经心房调搏有5例可引发δ波,4例为 B 型,1例为 A 型,其中1例合并房室结双径路。1例为马海姆氏束合并房室结三径路。另2例为真性隐匿型预激综合征,行心房词搏不能引发δ波,经心室调搏,根据逆传 A 波证明右侧旁路1例,间隔部1例。显示δ波的5例旁路前向传导的 ERP 均值为426±16.25ms,而房室结前向传导 ERP 均值为306±34.90ms,两者间有显著差异(P<0.01)。此5例隐匿型预激前向传导的 ERP 明显长于我院经电生理检查的22例显性预激 ERP230～350ms 的时间。本文讨论了隐匿型预激平时 ECG 正常的原因;发生 AVRT 时旁路所起的作用;及马海姆氏束合并 AVNRT时所起的作用。隐匿型预激经常发生 AVRT,经电生理检查可以证实旁路的存在及初步定位,为手术切断旁路起了非常重要的作用,例3、4经手术治疗效果良好。若隐匿型预激合并房室结双径路则不能行手术治疗。

Electrophysiological study was done on 30 patients with W-P-W syndrome.Amongthese patients,8 cases of latent W-P-W syndrome in which there were 4 of typeB,1 of type A,2 of septal patterns and 1 of Mahaim pattern were found in exami-nation.The ERP(effective refractory period)of accessory pathway for preexcitationwas 426±16.25ms and that of the atrioventricular node was 306±34.9ms(P<0.01).In8 patients with latent W-P-W syndrome,attacks of PSVT were initiated by RA PES,two patients with PSVT showed accessory pathway with dual or triple AV node con-duction.During the initiation of AVRT,the antegrade conduction was through bothfast and slow pathways alternatively in case Ⅰ;the retrograde conduction was viathe concealed bypass tracts during episodes of taehycardia.The ventriculars were ac-tivated through Mahaim nodoventricular bypass tract originating in the Right bundlebranch.The antegrade conduction was through slow pathwary,retrograde conductionwas via the fast AV node pathway during the episode of tachycardia in case Ⅱ.2 of8 cases were successfully operated.