心房扑动伴交替性文氏现象的心电图与临床分析

ECG characteristics and clinical analysis of atrial flutter complicating alternating Wenckebach phenomenon

目的探讨心房扑动伴交替性文氏现象的心电图特点与临床意义。方法回顾性分析13例心房扑动伴交替性文氏现象患者的临床资料。根据心电图表现,将这13例患者分为A、B两型。结果 13例患者中10例患器质性心脏病,3例为非器质性心脏病患者。10例器质性心脏病患者中有7例经胺碘酮或普罗帕酮复律转为窦性心律时,仍存在一度房室阻滞或二度Ⅰ型房室阻滞,提示此7例交替性文氏现象多为病理性阻滞;3例非器质性心脏病患者中有2例(肺炎、创伤性颅脑损伤)恢复窦性心律未见房室阻滞,提示为功能性阻滞。所有患者均获临床治愈或好转出院。结论心房扑动伴交替性文氏现象为房室结双层阻滞,B型略多于A型。该现象如果见于器质性心脏病患者,恢复窦性心律多数存在房室阻滞,提示可能为病理性阻滞。如果为病理性阻滞,应用抗心律失常药物时应适当减量,以免发生高度或三度房室阻滞。

Objective To discuss the ECG characteristics of atrial flutter complicating alternating Wenckebach phenomenon and corresponding clinical significance. Methods Retrospective analysis was performed on clinical data of 13 patients with atrial flutter complicating alternating Wenckebach phenomenon. According to ECG manifestations, the research objects can be classified into type A and B. Results Ten out of 13 cases were patients with organic heart disease and 3 were non-organic-heart-disease one. Among the 10 organic-heart-disease patients, first degree atrioventricular block ( AVB ) or second degree typed I AVB still remained in 7 cases after conversion to sinus rhythm with amiodarone or propafenone. It implied that alternating Wenckebach phenomenon in the 7 cases were mainly pathological block. Two ( patients with pneumonia and traumatic brain injury) out of the 3 patients without organic heart disease restored to sinus rhythm and no AVB was found, suggesting functional block. All the 13 patients were clinically cured, or improved and discharged from hospital. Conclusion Atrial flutter complicating alternating Wenckebach phenomenon is actually double layer block of atrioventricular node, and type B is slightly more than type A. If the phenomenon is seen in patients with organic heart disease, AVB mostly exists after conversion to sinus rhythm, suggesting a possibility of pathological block. If it is, the dose of antiarrhythmic drugs should be reduced adequately to avoid high or third degree AVB.