左后间隔隐匿性旁道的特殊表现形式及临床特点

A special manifestation and clinical characteristics of the concealed left posterior septal pathway

目的:分析一组以宽QRS波心动过速为表现形式的左后间隔隐匿性旁道的发病心电图、临床和电生理特点。方法:对本中心10例表现为宽QRS波心动过速的左后间隔隐匿性旁道进行回顾性分析研究(宽QRS波组),采用10例表现为窄QRS波心动过速形态的左后间隔隐匿性旁道作为对照组(窄QRS波组)。比较两组患者的一般情况、临床症状、误诊情况、电生理检查结果和射频消融情况。结果:与窄QRS波组相比,宽QRS波组心动过速均表现为左束支阻滞(LBBB)形态差异性传导,发作时心率更快[(206±14)vs.(183±8)次/min,P<0.05],心电图容易被当地医院误诊为室性心动过速(5例)或无法明确诊断(3例),临床症状严重,除心悸(10例)外,还会表现为晕厥(2例)、头晕(4例)或者胸痛(2例)等,容易被医生过度检查或者过度治疗(4例行冠状动脉造影检查,3例被建议安装置入式心脏除颤装置)。两组患者电生理特征包括房室结不应期、文氏点、旁道传导功能等未见明显差异。两组患者消融成功率均为100%,所需电生理检查时间、标测和射频消融时间也无明显差别。结论:左后间隔隐匿性旁道可以表现为LBBB形态的宽QRS波心动过速,此类患者发作时心率快、症状重,容易被误诊为室上性心动过速而过度检查和治疗。此类患者应行电生理检查明确诊断。

Objective:To summarize and analyze the electrocardiogram,clinical and electrophysiolog-ical characteristics of a group of concealed left posterior septal pathway in the form of wide QRS complex tachy-cardia.Methods:10 cases of the concealed left posterior septal pathway in the form of wide QRS complex tach-ycardia were retrospectively studied(wide QRS group),and 10 cases of the concealed left posterior septal path-way in the form of narrow QRS complex was used as the control group(narrow QRS group).Results:There was no significant difference in basic clinical data between the two groups.Compared with the narrow QRS group,the tachycardia of wide QRS group showed an aberrant ventricular conduction with left bundle branch block(LBBB)morphology,the tachycardia frequency was faster(206±14)vs.(183±8)time/min(P<0.05),and the electrocardiogram was likely misdiagnosed as ventricular tachycardia(VA)(5 cases)or hardly diagnosed(3 cases)at the local hospital.The clinical symptoms were diverse and severe,including palpitation(10 ca-ses),syncope(2 cases),dizziness(4 cases)and chest pain(2 cases).They were likely over-examined or o-ver-treated(4 cases of coronary angiography,3 cases recommended ICD)in local hospital.There were no sig-nificant differences in the electrophysiological characteristics of the two groups of patients,including AV node refractory period,Wenckebach’s point and pathway conduction function.Electrophysiological examination time,mapping and radiofrequency ablation time and the success rate between these two groups showed no differences.Conclusions:The concealed left posterior septal pathway can manifest as wide QRS tachycardia with LBBB morphology.This kind of tachycardia showed a fast frequency,severe symptoms,and might be likely misdiag-nosed,over-examined or over-treated.Standard electrophysiological examination and radiofrequency ablation were very important for such patients.