预激综合征合并束支传导阻滞32例心电图特征分析

目的 探讨预激综合征合并同侧或异侧束支阻滞的心电图特征及其图形形成机制.方法 回顾性分析32例已确诊的预激综合征合并束支阻滞的心电图特征并进行分类.结果 A型预激合并右束支阻滞17例,A型预激合并左束支阻滞1例；B型预激合并右束支阻滞8例,B型预激合并左束支阻滞6例.结论 旁路与束支阻滞位于同侧时,束支阻滞的心电图特征一般可被掩盖；旁路与束支阻滞位于异侧时,束支阻滞的心电图特征一般不会被掩盖,但并非绝对,这可能与旁路附着心室的部位,旁道传导速度及旁道距传导阻滞束支的距离等因素有关.     

在健康查体中常规心电图对伪性右束支阻滞识别与评估

目的探讨不完全性右束支阻滞与伪性右束支阻滞的检出率及附加导联识别作用。方法健康查体采用心电图常规F导联25 318例,旨对伪性右束支阻滞图形4 219例应用附加导联即右胸导联及V_1、V_2导联提高1肋或2肋导联记录读析。结果本组检出伪性右束支阻滞检出率为4 219例(16.66%)。其典型不完全性右束支阻滞1 125例(26.66%)、非典型不完全性右束支阻滞955例(22.64%)、室上嵴图形401例(9.50%)、Brugada波602例(14.27%)、早期复极变异1 097例(26.00%)、不典型预激综合征39例(0.92%)。结论熟悉掌握伪性右束支阻滞诊断特征,当心电图V_1导联呈r Rr`时,附加导联提高1或2肋记录r`无增高或rr`及V3R的r`消失,其S波无粗顿40 ms,可作为鉴别伪性右束支阻滞的鉴别依据。     

小儿室间隔缺损封堵术并发心律失常的护理

目的探讨小儿室间隔缺损（VSD）经导管封堵术后心律失常的特征、防治,总结护理措施。方法选择2001年6月-2007年12月在我科住院并成功接受经导管封堵术的166例小儿VSD患者为研究对象,对封堵术中持续心电监护和术后1～7d常规心电图报告进行回顾性分析,总结心律失常发生的类型。结果166例小儿VSD患者术后心律失常明显增加;术后新发不完全性右束支传导阻滞（IRBBB）10例,完全性右束支传导阻滞（CRBBB）8例,加速性交界性心动过速伴干扰性房室分离4例,左前分支阻滞4例,CRBBB加左前分支阻滞2例,高度房室传导阻滞（AVB）5例。结论小儿VSD封堵术后新发生的心律失常以心脏传导阻滞为主,早期激素治疗有效,预后良好。     

100IR远程心电检测仪在心律失常射频消融术后患者中的应用

目的:探讨远程心电检测仪在心律失常射频消融术后应用中的临床意义。方法:以心律失常射频消融术(RFCA)后的202例患者为研究对象,其中室性早搏患者85例,心房颤动和阵发性室上性心动过速患者各50例,预激综合征患者17例,应用100IR远程心电检测仪在其射频消融术后行心电图追踪监测。结果:本组202例患者共发送心电图4970行,其中干扰图384行(7.73%),记录良好的有效图4586行(92.27%)。85例室性早搏患者RFCA后,正常48例,频发室性早搏23例,偶发室早14例;50例心房颤动患者RFCA后,正常44例,阵发性心房颤动6例;50例心房颤动患者RFCA后无异常;17例预激综合征患者RFCA后无异常。结论:对心律失常RFCA术后患者应用100IR远程心电检测仪进行院外心电图监测,使用方便,获得的有效心电图率高,对心律失常RFCA术后的效果进行追踪评估具有重要的临床意义。     

预激综合征的另一种表现形式--假性不完全性右束支传导阻滞

W-P-W型预激综合征在体表EKG上表现为不同程度的心室预激波(б波),PR＜120ms及继发性ST-T段改变;而比较特殊的旁道(AP)如Mahaim氏束则不具备逆传功能,其正向传导速度亦较房室结(AVN)慢,仅在AVN处于不应期后才表现出来.我们在射频导管消融(RFCA)阵发性室上性心动过速(PSVT)过程中,通过腔内电生理检查发现3例极其罕见的左侧显性AP,其EKG仅表现为V1导联呈rSr'的不完全性右束支传导阻滞型,现报道如下.     

特勤人员右束支阻滞心电图特点及其健康鉴定

目的分析特勤人员右束支阻滞心电图特点，为其健康鉴定提供参考依据。方法逐例分析右束支阻滞心电特点及临床体检资料。结果右束支阻滞患病率为0.8％（47／5952），其中不完全性右束支阻滞29例（0．5％），完全性右束支阻滞18例（0．3％）；完全性右束支阻滞QRS时限在0．12～0．14s者12例（66．7％）、0．15～0．16s者6例（33．3％）；完全性右束支阻滞者QTc间期〉0．44s有5例（27培％），但JTc间期均正常（〈0．36s）；45例（95．7％）右束支阻滞存在多年无变化，健康鉴定结论合格，2例（4．3％）出现动态变化，定为暂不合格。结论特勤人员右束支阻滞绝大多数为非病理性，健康鉴定结论合格，但对右束支阻滞有动态变化或40岁以上发生者，应注意结合临床体检资料综合鉴定。     

室性心动过速终止后T波倒置2例分析

80年代以来,对右室起搏,间歇性右束支阻滞,间歇性预激综合征,室性或室上性心动过速终止后,心电图T波改变,国内报道较少。我们收治二例,现就临床特征、心电图特点进行分析,以期引起临床重视。     

心房颤动并预激综合征5例心电图分析

心房颤动合并预激综合征（以下称房颤并预激）是最危险的心律失常之一,部分房颤并预激演变为心室纤颤而引起猝死[1,2]。房颤并预激的宽QRS波心动过速心电图表现与室性心动过速较难鉴别,如将其误诊为心房颤动并束支阻滞则可导致治疗的严重错误。正确及时地做出房颤并预激的诊断对临床的紧急处理及患者的预后影响极大。本文报告5例房颤并预激的动态心电图进行分析如下。     

发热引起Ⅰ型Brugada波样心电图改变1例及相关文献复习

1992年，西班牙学者Brugada等报道了一种猝死综合征，其心电图表现为右束支阻滞、右胸导联（V1～V3）ST段提高。1996年，日本Miyazaki等首次将上述心电图异常伴猝死者称为Brugada综合征。目前，一些文章报道非Brugada综合征患者心电图也可出现Brugada波样改变。我们发现1例发热患者心电图出现Ⅰ型Brugada波，现报告如下。     

矫正型大动脉转位一例

患者女,40 岁,因妇科子宫肌瘤入院治疗,入院后手术前常规检查心电图.患者述近1 年来时有心悸、气短、乏力,既往体健无不适.查体:二尖瓣听诊区可闻及Ⅲ～Ⅳ/6 级收缩期杂音.心电图检查(图1):窦性心律,Ⅰ度房室传导阻滞,异常Q 波(Ⅲ、avF、V1),不完全性左束支传导阻滞,间歇性预激综合征(A 型).     

Electrophysiologic characteristics and radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome

BACKGROUND: The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. METHODS: From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. RESULTS: The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001).Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. CONCLUSION: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.     

Coexistent Brugada Syndrome and Wolff‐Parkinson‐White Syndrome: What Is the First Clinical Presentation?

The coexistence of Brugada syndrome and Wolff-Parkinson-White (WPW) syndrome is a very rare phenomenon. We describe a 31-year-old patient without any previous cardiac disorder admitted to our hospital due to palpitations and concomitantly diagnosed as WPW syndrome and treated with radiofrequency catheter ablation. He was later diagnosed with Brugada syndrome and followed-up 2 years without any symptoms. We discuss other previously reported cases in literature, in which these two conditions exist simultaneously.     

Preexcitation syndrome

Atrial fibrillation occurring in patients with Wolff-Parkinson-White(WPW) syndrome is a potentially life threatening arrhythmia because it lead to ventricular fibrillation which may be caused by a rapid ventricular response because of one or multiple accessory pathways with a very short anterograde refractory period. The incidence of sudden cardiac death by ventricular fibrillation in the WPW syndrome ranged from 0 to 0.6%. To avoid the sudden cardiac death, atrial fibrillation in the WPW syndrome should be terminated immediately by direct current cardioversion or intravenous administration of antiarrhythmic drug, especially sodium channel blocker. Radiofrequency catheter ablation on the accessory pathways is a first line treatment to prevent ventricular fibrillation.     

Inheritance of Wolff-Parkinson-White syndrome and evolution of its clinical symptoms in families of patients in a prospective trial

Medicogenetic examination was conducted in families of 46 patients (21 women and 25 men aged 16-74 years) with Wolff-Parkinson-White (WPW) syndrome. A total of 256 relatives were investigated (136 women and 120 men aged 2 to 85 years). As a result, the diagnosis of preexcitation syndrome and phenomenon was made initially in 75(29.3%) of the relatives: WPW syndrome, Clerc-Levy-Cristesco (CLC) syndrome, CLC phenomenon was made in 6(2.3%), 27(10.6%) and 42(16.4%) relatives, respectively. Additional conduction pathways in the families with WPW syndrome are inherited by the autosome-dominant type with penetrability 0.94(94%) and clinical polymorphism. Prospective observation of the families revealed evolution of the clinical symptoms (development of arrhythmia) in the relative with CLC or WPW phenomenon in unfavorable exo- and endogenic factors. WPW syndrome evolution in the patients ran with aggravation of arrhythmia though 12 patients showed improvement.     

Advances in ablation surgeries for dysrhythmias associated with Wolff-Parkinson-White syndrome.

Management of dysrhythmias associated with WPW syndrome must be individualized. A detailed EPS in selected patients should be done to assess the location of accessory pathways and the efficacy of antiarrhythmic medications. Palliative treatment used in the prevention of SVT would include a pharmacologic approach or perhaps an antitachycardia pacemaker. Curative methods for treating the SVT associated with accessory pathways of WPW syndrome include ablative techniques. Surgical ablation is currently accepted as the gold standard of treatment, but catheter ablation offers promising hope as an adjunctive therapy in treating patients with WPW syndrome.     

Wide Complex Tachycardia Due to Automaticity in an Accessory Pathway

Patients with the Wolff-Parkinson-White (WPW) syndrome have preexcited tachycardia as the result of atrial arrhythmias or antidromic reentry. This article describes a patient with persistent wide complex tachycardia due to abnormal automaticity in the accessory pathway. Radiofrequency catheter ablation resulted in simultaneous elimination of accessory pathway conduction and automaticity. Accessory pathway automaticity may be an infrequent cause of preexcited tachycardia in patients with the WPW syndrome.     

Successful stenting of a left main coronary artery occlusion as a complication of RF ablation for Wolff-Parkinson-White syndrome

Wolff-Parkinson-White (WPW) syndrome is a disorder characterized by presence of an accessory pathway that predisposes patients to tachyarrhythmias and sudden death. Radiofrequency ablation (RFA) is both effective and safe for patients with symptomatic tachyarrhythmias mediated by accessory atrioventricular pathways. During the procedure, fatal complications may occur but it is considered low in relation to the morbidity associated with the WPW syndrome. Coronary artery occlusion, as a complication of an RF catheter ablation, is quite rare. In this report, we present a 56-year-old male patient with a left main coronary artery (LMCA) occlusion during the ablation of left anterolateral wall accessory pathway. It should be kept in mind if the patient complains of new onset of severe chest pain, an immediate angiography should be performed.     

经食管超声心动图引导射频消融术大头电极导管到位的实验研究

目的 :研究经食管超声心动图 (TEE)作为影像学引导射频导管消融术 (RFCA)时大头电极导管到位的可行性。方法 :5只健康杂种犬 ,分别由 TEE引导大头电极导管入左心和右心系统。结果 :TEE引导大头电极导管到左、右心相应部位的成功率均为 10 0 %。结论 :TEE可引导 RFCA时大头电极导管的顺利到位     

1例儿童无症状预激综合征的循证治疗

目的为1例无症状预激综合征儿童患者循证制定治疗方案。方法针对无症状预激综合征患儿是否需要进行预防性射频消融的问题，以“asymptomatic WPW syndrome”为检索词，全面检索Cochrane图书馆（2007年第3期）、MEDLINE（1981—2007）、OVID ACP Journal Club（1991—2007）、BM JClinical Evidence（1999～2007）以及美国国家指南交换中心（1998～2007），获取并评价相关的系统评价、随机对照试验、临床对照试验证据及治疗指南，并将最佳证据用于临床治疗。结果从MEDLINE检索到2篇随机对照试验，结果表明：高危对照组与消融组相比，心律失常事件发生显著增加，高危对照组中多旁道患者比单旁道患者心律失常事件发生显著增加。据此，我们结合医生经验和家长意愿，针对该例患者电生理检查示右侧显性旁道和左侧隐匿性旁道，进行预防性射频消融治疗。出院至今已12个月，未再出现心血管方面的并发症。结论对高危无症状预激综合征患儿进行预防性射频消融安全、有效。     

The use of echocardiography in Wolff–Parkinson–White syndrome

Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff–Parkinson–White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80–90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.