预激综合征的诊断及治疗原则

WPW syndrome diagnosis and treatment principles

预激综合征是指起源于心房的激动经旁路提早激动心室的一部分或全部。Kent氏束的存在形成了典型的预激综合征(W-P-W综合征),发病率约为0.1‰～0.3‰。7%～20%的患者同时合并其他先天性心脏病,如Ebstein畸形。预激综合征可分为显性、间歇性、不完全潜在性、潜在性及隐匿性预激等;与其相关的快速性心律失常包括房室折返性心动过速以及房性异位激动经旁道下传心室。预激的存在有时会加大心电图的诊断难度,如预激酷似或掩盖心肌梗死、预激掩盖束支阻滞等;消除δ波有利于鉴别诊断。预激综合征一般预后较好,治疗方法首选射频消融术。

Pre-excitation syndrome is an electrocardiographic pattern in which all or part of the ventricular muscles can be activated sooner than normal due to atrial activation by accessory pathway. The existence of the bundle of Kent contributes to formation of the classic pre-excitation syndrome （the so-called Wolff-Parkinson-White syndrome, WPW syndrome）, with an incidence rate of about 0.1‰-0.3‰ and 7%-20% of these patients are complicated with other congenital heart diseases（such as Ebstein’s anomaly）. WPW syndrome can be categoried by manifest pre-excitation, intermittent pre-excitation, incomplete latent pre-excitation, latent pre-excitation and concealed pre-excitation. Tachyarrhythmia related to WPW syndrome includes atrioventricular reentrant tachycardia and atrial ectopic activation down the ventricle through accessory pathway.The existence of pre-excitation could probably make it harder for ECG diagnosis of some diseases. For example, pre-excitation is always exactly like or conceals myocardial infarction or bundle branch block and so on. Therefore, elimination of δ wave could help in differential diagnosis.Generally, pre-excitation syndrome has a good prognosis and radiofrequency ablation has become a preferred treatment.