食管心房调搏宽 QRS 波与隐性心室预激的相关性

The correlation between wide QRS of transesophageal atrial pacing and implicit ventricular pre-excitation

目的：探讨食管心房调搏宽QRS波与隐性心室预激的相关性。方法将77例行食管心房调搏检查（TEAP）的患者根据心电图结果不同分为两组，Ⅰ组45例患者心电图正常，经心内电生理检查（EPS）排除存在隐性心室预激；Ⅱ组32例患者心电图显性心室预激，并经EPS证实。Ⅰ组患者TEAP显示电脉冲波（ S波）后间断或连续呈宽 QRS 波群图形，并测量 SR 间期，同时与Ⅱ组患者的 TEAP 进行对比分析。结果（1）Ⅰ组患者中20例（ⅠA组）为心室起搏，TEAP究其图形显示S波后紧随宽大QRS波群呈右束支阻滞图形，SR为0 s；25例（ⅠB组）SR间期不固定，SR为（0．07±0．01）s，S波与QRS波无关，为室性期前收缩，QRS波群形态据期前收缩起源点不同而不同。（2）Ⅱ组患者TEAP检查过程中S波后有紧密相关的心房除极P波，经过较正常缩短的房室传导时间后出现起始有预激波的宽大 QRS波群，SR间期固定，SR为（0．08±0.03）s，同时不同部位旁道QRS波群有不同形态特征。（3）ⅠA组与ⅠB组、Ⅱ组SR间期差异有统计学意义（t＝2．97、3．02，均P＜0．05）；而ⅠB组与Ⅱ组SR间期差异无统计学意义（t＝2．66，P＞0．05）。结论当食管心房调搏检查起搏宽QRS波群时，应综合分析，不应盲目认为是隐性预激旁道，避免给患者带来误诊治。

Objective To explore the correlation between wide QRS of transesophageal atrial pacing （TEAP） and implicit ventricular pre-excitation.Methods 77 patients tested by TEAP were divided into two groups according to the ECG results .45 patients in group Ⅰhad normal electrocardiogram .32 patients in group Ⅱhad ven-tricular pre-excitation.In group Ⅰ,TEAP results showed that electric pulse wave （S wave） was followed by intermit-tent or continuous wide QRS complex .At the same time , the results of group Ⅰ were compared with the results of groupⅡ.Results （1）The patients of group Ⅰwere excluded the presence of concealed accessory pathway by intra-cavitary electrocardiographic test,among them 20 patients （group ⅠA） were ventricular pacing,the test results dis-played that S wave was followed by wide QRS complex exhibiting a pattern of right bundle branch block （ RBBB） ,SR interval was 0 s;SR intervals of 25 patients （groupⅠB） were not fixed,SR interval was （0.07 ±0.01）s,S wave had no concern with QRS wave ,the wide QRS complex was premature ventricular contraction ,QRS wave shapes were dif-ferent according to the different sites of pacing origin .（2）In groupⅡ,the test results displayed that S wave was close-ly followed by the atrial depolarization wave P ,and there was a wide QRS complex with pre-excitation wave at the be-ginning after a atrioventricular conduction time shorter than normal ,SR interval was fixed ,SR interval was （0.08 ±0. 03）s,at the same time,different parts of accessory pathway QRS complex had different morphological characteristics . （3） SR interval of ⅠA group compared with groupⅠB and groupⅡ,the differences were statistically significant （ t=2.97,3.02,all P〈0.05）;SR interval had no statistically significant difference between group ⅠB and groupⅡ（t=2.66,P〉0.05）.Conclusion When TEAP displaying pacing wide QRS complex ,in order to avoid bringing misdiag-nosis,TEAP results should be analyzed comprehensively rather than blindly believing that the reason was concealed accessory pathway .