窦性P波形态突变或多变的心电图分析

Electrocardiographic analysis of sinusoidal P wave mutation or change

目的探讨影响窦性P波突变或多变的原因,揭示其临床意义。方法收集从2014年6月~2017年6月期间于南阳市中心医院心电生理科做常规心电图的患者,将出现窦性P波突变或多变的心电图进行分析归类,选择120例患者纳入研究,把出现同一种窦性P波突变或多变的心电图列为一组,分析其心电图特点及形成原因。结果窦房结内游走节律患者共86例,窦房结内两个起搏点间歇性发放激动共4例,间歇性不完全性左心房、右心房内阻滞引发两种P波形态共6例,左心房肥大合并间歇性不完全性右心房内阻滞引发两种P波形态共5例,右心房肥大合并间歇性不完全性右心房内阻滞引发两种P波形态共5例,慢频率依赖性不完全性左心房内阻滞引发两种P波形态共2例,药物引发的一过性右心房内反向文氏现象引发P波形态多变,间歇性不完全性右心房或/和左心房内阻滞、房性早搏诱发右心房内韦金斯基现象引发两种P波形态共2例,另外还有成对房性早搏引发钟氏现象、房性早搏后引发钟氏现象和短阵性房性心动过速后引发钟氏现象。结论窦性P波形态突变或多变的患者典型心电图特征主要归纳为10类特点。

Objective To explore the causes of mutations or mutations in sinusoidal P waves and to reveal their clinical significance.Methods Electrocardiogram with sinus P-wave mutations or changes was analyzed and classified for patients undergoing routine electrocardiograms at the Electrophysiology Department of Nanyang Central Hospital from June 2014 to June 2017.120 patients were included in the study.Patients had the same type of sinus P-wave mutation or change were enrolled in same group.The ECG characteristics and the reasons for its formation are analyzed.Results A total of 86 patients with rhythm of sinus node walk were studied.There were 4 cases of intermittent activation in the sinoatrial node.Intermittent incomplete left atrium and right atrial block caused two P wave patterns in 6 cases.Left atrial hypertrophy with intermittent incomplete right atrial block caused two P wave morphology in 5 cases.Right atrial hypertrophy with intermittent incomplete right atrial block caused two P wave morphology in 5 cases.Slow frequency-dependent incomplete left atrial block caused two P wave patterns in 2 cases.The drug-induced transient right atrial inverted Venturi phenomenon caused P wave shape changes.Intermittent incomplete right atrium and(or)left atrial block,atrial premature beats induced right atrial Nevequinsky phenomenon caused two P wave morphology in 2 cases.In addition,paired atrial premature beats,atrial premature beats,and short-term atrial tachycardias all caused the Chung's Phenomenon.Conclusions The characteristics of typical electrocardiogram in patients with sinusoidal P wave morphological changes or mutations are mainly classified into 10 types.