房室结双径路传导在动态心电图上的不同表现

Various Manifestations of Dual Atrioventricular Nodal Pathway Conduction on Dynamic Electrocardiography

目的 探讨房室结双径路传导引起的心电图表现及其形成机制.方法 对27例患者动态心电图中出现的房室结双径路现象进行回顾性分析.结果 房室结双径路传导表现为9种心电图特征：顺向房室传导呈跳跃现象,无心房回波,呈不典型文氏现象及反文氏现象;顺向房室传导呈跳跃现象,伴心房回波,呈不典型文氏现象;顺向房室传导呈跳跃现象,隐匿性逆传快径路连续发生蝉联现象,貌似阵发性室上性心动过速;房性或室性期前收缩诱发慢-快型或快-慢型房室结折返性心动过速;房室结下部共同通道阻滞不中止折返环;窦性P波分别经快、慢径路传导致心室双反应（即房室结双径路的1∶2传导现象）;经慢径路或慢快径路交替顺传、旁道逆传的房室折返性心动过速.结论 动态心电图上P-R间期呈跳跃现象提示存在房室结双径路.

Objective To explore the electrocardiographic characteristics of dual atrioventricular nodal（AVN） pathway conduction and its mechanisms. Methods The dynamic electrocardiography was analyzed retrospectively in 27 pa- tients with dual AVN pathways. Results Dual AVN pathway conduction manifested by 9 electrocardiographic patterns： Anterograde AVN conduction with a jump of P-R and no atrial echo resembled atypical wenckebach and reverse wenckebach patterns. Anterograde AVN conduction with a jump of P-R and an atrial echo resembled atypical wencke- bach pattern. Anterograde AVN conduction with a jump of P-R and concealed retrograde conduction over fast pathway resulted in linking phenomenon, which resembled paroxysmal supraventricular tachyeardia. Atrial or ventricular premature beat induced slow-fast or fast-slow AVN reentrant tachycardia. The block at distal common pathway of AVN did not in- terrupt reentry circuit. One sinus p wave conducted simultaneously over fast and slow pathways and induced dual ven- tricular activations. Atrioventricular reentrant tachycardia involved reentry with antegrade conduction over slow pathway or over slow and fast pathways alternately and retrograde conduction over accessory pathway. Conclusion A jump of P-R interval on dynamic electrocardiography may implicate the presence of dual AVN pathways.