不全显性预激的心电图分析

Analysis of ECG of atypical WPW syndrome patients with left pathway

目的评估有左侧前传旁路伴房室折返性心动过速且无器质性心脏病患者中,体表心电图无典型预激表现患者所占的比例,并分析造成预激图形不明显的原因,以在定位旁路时借鉴。方法 2007年1月至~2009年11月入院的行房室折返性心动过速导管射频消融术的左侧前传旁路的46例患者进行回顾性分析,计算术前V1导联QRS波群非主波向上者的比例（不典型旁路组）,以患者术前及术后PR间期为窦性激动经旁路下传和经房室结下传的时间间期,记录窦性心律时AH间期,以体表心电图P波最早起点至冠状窦口A波起点的间期（PA间期）为窦性激动传至左房的时间,同时记录旁道距冠状窦口的距离;用t检验比较两组患者各参数。结果在所收集患者中,V1导联R（r）〈S（s）者占左侧前向传导功能旁路者的19.6%;②不典型旁路组患者术后PR间期及AH间期较典型旁路组患者短,有显著性差异;术前PR间期无差异;③不典型预激组与典型预激组患者PA间期无差异;④两组间患者旁路距冠状窦口距离无显著性差异。结论有19.6%左侧前传旁路患者体表心电图呈不典型预激,房室结功能较好是造成经旁路前传成分少,V1导联R（r）〈S（s）的主要原因。

Objective To evaluate the ratio of patients excluding organic heart diseases who have atypical manifestation in surface electrocardiogram（ECG） of left accessory pathway（AP） which have antegrade conduction and the cause of this phenomenon was analyzed simultaneously to help to understand the mechanism and locate the AP Position.Methods Forty-six patients with antegrade conductive AP admitted from Jan.2007 to Nov.2009 underwent radiofrequency catheter ablation（RFCA） were analyzed retrospectively.The ratio of the atypical ECG manifested as downward main wave of QRS complex of lead V1 in patients（atypical AP group） of left accessory pathway（AP） which have antegrade conduction before ablation was calculated.The AH intervals of sinus rhythm were collected.The earliest origin of P wave in ECG to A wave of orifice of coronary sinus（PA intervals） were collected as the duration of sinoatrial node to left atrium.The distance of AP to orifice of coronary sinus（CSo）（DAP-CSo） was gathered also.Two tailed t test was used to compare all the variations.Results The ratio of RS of lead V1 was 19.6% in left antegrade conduction AP.The difference of PR after ablation and AH were significant between two groups while no difference was observed in PR before ablation between two groups.The PA was not prolonged in atypical AP group.There was no significant difference of DAP-CSo between the two groups.There was no significant difference between two groups.Conclusions There was 19.6% patients with left antegrade conduction AP was atypical in ECG.The better conduction of atrioventricular node was the important cause of less ventricular excitation originated from AP and R（r）S（s） in V1 in these patients.