显性预激射频消融对心室肌复极变化的影响

Effects of radiofrequency catheter ablation of manifested preexcitation on the repolarization of ventricular myocardium

目的长期显性预激可引起心室肌复极变化,显性预激对心肌复极的影响目前研究较少。文中探讨射频消融术后心肌复极改变与旁路位置及Δ波向量方向的关系。方法成功施行射频消融的显性旁路患者46例,比较消融前后心电图各参数的变化,并依据旁路位置、Δ波向量方向分组,比较消融前后心电图的ST段及T波的变化。结果消融后ST段抬高及T波高耸在各组旁路均出现,T波倒置主要在左右后壁、左右后间隔。ST段抬高、T波高耸均出现于Δ波呈(+)的导联,而ST段压低、T波倒置主要出现于Δ波呈(-)的导联,少数出现于Δ波呈(±)的导联。结论长期显性预激可通过电张力调整机制引起预激部位心肌除极、复极异常,导致ST-T改变,这种改变与旁路位置及Δ波向量方向有关。

Objective Long-term manifested preexcitation can cause changes in the repolarization of ventricular myocardi- um, on which there are very few studies. This article aims to investigate the relationship of these changes after radiofrequency catheter ablation （RCA） with the location of the accessory pathway and the vector of △ waves. Methods We successfully performed RCA for 46 patients with manifested single accessory pathway, divided the patients into different groups according to the location of accessory pathways and the vector of △ waves, and compared the electrocardiographic changes in the ST segment and T waves before and after RCA. Results After RCA, the elevations of the ST segment and T waves were observed in all the groups, the inversion of T waves mainly in the left and right posterior walls and left and right posterosepta, the elevations of both the ST segment and T waves in the lead A wave （＋） , and the depression of the ST segment and inversion of T waves mainly in the lead A wave （-） with a little in the lead △ wave （＋）. Conclusion Long-term manifested preexcitation can cause abnormal depolarization and repolarization of the ventricular myoeardium by electronic modulation, and further lead to the change of ST-T, which is correlated with the location of the accessory pathway and the vector of △ waves.