心房扑动伴交替性文氏现象的心电图与临床分析

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。

ECG characteristics and clinical analysis of atrial flutter complicating alternating Wencke-bach phenomenon

Objective To discuss the ECG characteristics of atrial flutter complicating alterna-ting Wenckebach phenomenon and corresponding clinical significance.Methods Retrospective a-nalysis was performed on clinical data of 1 3 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 1 3 cases were patients with organic heart disease and 3 were non-organic-heart-disease one.Among the 1 0 organic-heart-disease patients,first degree atrioven-tricular block(AVB)or second degree typed Ⅰ AVB still remained in 7 cases after conversion to si-nus 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 inju-ry)out of the 3 patients without organic heart disease restored to sinus rhythm and no AVB was found,suggesting functional block.All the 1 3 patients were clinically cured,or improved and dis-charged 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.