短PR综合征合并室上性心运过速的电生理特性研究

目的 探讨短ＰＲ综合征ＰＲ缩短的以及合并的室上性心动过速的电生理机制。方法 对既往射频消融病例中具有短ＰＲ和ＱＲＳ波正常的２６例患者的电生理特性进行了研究，并与同期ＰＲ间期正常的２８例室上性心动过束宫物电生理特性进行了对比观察。结果 １组（短ＰＲ组）的ＡＨ间期和ＡＶ间期明显短于Ⅱ组（ＰＲ间期正常组）的ＡＨ间期和Ａ－Ｖ间期，差异有显著性，Ｐ〈０．０１；Ⅰ组室上性民 过速的电生理机制是２０例为房室结折     

短PR综合征电生理特点及射频导管消融治疗

PR间期≤0.12 s,QRS形态正常,称为短PR综合征,常伴阵发性室上性心动过速(paroxysmol supraventricular tachy-cardia,PSVT),本文回顾分析我院6例短PR综合征电生理检查及射频导管消融治疗,以探讨其电生理机制和治疗方法.     

短P-R间期综合征的电生理特征及临床意义

短P-R间期综合征是临床上较常见的疾病,可有反复发作的心动过速.其体表心电图的特点是:①窦性心律时P-R间期＜0.12 s;②QRS波群正常,起始部无预激波.通过对19例短P-R间期综合征病人生理检查结果的分析,对其电生理特征及临床意义总结报告如下.     

短P—R综合征合并室上性心动过速的电生理观察

为探讨短Ｐ－Ｒ综合征合并室上性心动过速的电生理机制,对７例短Ｐ－Ｒ综合征合并室上性心动过速的患者进行心内电生理检查。结果发现：随着心房负扫描程序刺激,６例Ａ－Ｈ间期逐渐延长,１例间歇性延长,６例有Ａ－Ｈ间期跳跃现象;室上性心动过速时６例最早心房激动部位在希氏束,Ｖ－Ａ间期〈７０ｍｓ,１例在左后游离壁,Ｖ－Ａ间期〉７０ｍｓ。提示短Ｐ－Ｒ综合征合并室上性心劝过速的电生理机制是房室结加速传导合并房室结双     

房室递减传导的短PR综合征一例

1例患者,男性,37岁。有胸闷心悸史,无心动过速发作史,窦性心律时,PR间期0.10s,余正常。电生理检查时,窦性心律时AH间期24ms,HV间期37ms。高位右房刺激示房室传导呈递减性质,可见裂隙现象。提示该例为房室递减传导的短PR综合征。     

阵发性室上性心动过速的电生理特征

阵发性室上性心动过速(PSVT)是常见的心脏急症之一,任何年龄均可发病。大部分病人平时健康,发作PSVT时可出现心悸、胸闷,严重者可致低血压或急性心力衰竭,心室率在140～200次/分,律规整。一、PSVT的发生机理近年来,随着心内记录和程序刺激技术的发展和完善,对PSVT的发生机理有了更深刻的了解。其主要发生机理为:①异位激动点兴奋性增高,电     

食管电生理诊断阵发性室上性心动过速

目的探讨食管电生理诊断阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)及分型的准确性。方法收集经食管电生理和心内电生理检查并行射频消融治疗的PSVT42例,将两种电生理对PSVT的诊断及分型进行比较,用X2检验,以P<0.05为差异有统计学意义。结果两种电生理检查诊断房室结双径路、慢快型房室结折返性心动过速、常见的顺向型房室折返性心动过速差异无显著性,食管电生理对房室旁路的粗略定位准确性较高,但对快慢型房室结折返性心动过速、慢房室旁路参予的房室折返性心动过速与房性心动过速不易辨别。结论食管电生理诊断常见类型的PSVT与心内电生理有相似的价值,且具有无创、简便、费用低等优点;但对不常见或复杂的PSVT不易辨别。     

妊娠中晚期短PR间期130例报告

目的观察妊娠中晚期孕妇心电图PR间期的表现。方法回顾分析我院2004-2006年916例健康待产妇女的心电图资料,并以同期健康体检的900例非妊娠妇女作为对照,观察记录短PR间期的发生率。结果观察组短PR间期者130例（14.19%）,均出现于妊娠中晚期,观察组短PR间期发生率高于对照组（0.89%）,P〈0.01。短PR间期孕妇于分娩后6个月复查心电图,仍有9例（0.98%）心电图表现为短PR间期,与对照组比较无明显差异。结论妊娠中晚期易出现短PR间期。     

多形性室上性心动过速的电生理鉴别诊断

12例多形性室上速,自发或诱发的心速 QRS 波表现为2种或2种以上形态。通过一系列无创性心脏电生理检查,证实房室间存在多种传导通路,各传导通路之间在不应期和传导速度上的差异,有利于形成多种折返环路,是多形性室上速发生的主要机理。     

孕妇短PR间期与甲状腺激素水平的相关性分析

目的 探讨女性孕期短PR间期的发生率、机制及与甲状腺激素水平的关系.方法采用今科心电信息网络系统工作站对40301例健康体检者(其中女性未孕)及8257例健康孕妇分别进行常规心电图检查,采用化学发光免疫测定法测定孕期游离三碘甲腺原氨酸(free three iodine thyroid original ammonia acid,FT3),游离四碘甲腺原氨酸(free iodine thyroid original ammonia acid,FT4),促甲状腺素(thyrotropin,TSH).孕妇按孕周不同分孕早期(12周内)、孕中期(13~28周)和孕晚期(29周后)三组,分别进行PR间期及FT3、FT4、TSH的测定.结果健康体检者发生短PR间期120例(0.3%),其中男41例(0.102%),女79例(0.196%);孕妇短PR间期111例(1.344%),孕妇发生率明显增高,孕早中晚期的发生率两两比较,差异有统计学意义(P<0.01).FT3、FT4随孕周增加而降低,FT4在三组中两两比较,差异有统计学意义(P<0.05),TSH与孕周呈正相关,孕早中期比较差异无统计学意义(P>0.05),孕早中期与晚期比较差异有统计学意义(P<0.05).结论孕妇短PR间期发生率明显高于健康体检者,并与甲状腺激素水平有一定相关性.     

短QT综合征的诊断与治疗

目的 报道4例短QT综合征诊断和治疗的初步经验.方法 回顾总结4例短QT综合征的诊治过程,其中2例患者成功地实施电生理检杳和射频消融治疗.结果 1例住院期间猝死,1例药物治疗,2例行射频消融治疗.射频消融治疗的患者分别随访3年和4个月,无症状,未用抗心律失常药物,未见室性心律失常发作.结论 短QT综合征QT问期动态变化大,猝死风险高,射频消融可消除快速心律失常,可能是有效预防短QT综合征心脏性猝死的方法之一.     

Short-term repeatability of electrocardiographic P wave indices and PR interval

Background

P wave indices and PR interval from 12-lead electrocardiograms (ECGs) are predictors of cardiovascular morbidity and mortality, but their repeatability has not been examined.

Objectives

Determine the short-term repeatability of P wave indices (P axis, maximum P area and duration, P dispersion and P terminal force in V1) and PR interval.

Methods

Participants (n = 63) underwent two standard ECGs at each of two visits, two weeks apart. We calculated the intra-class correlation coefficient (ICC), weighted kappa, and minimal detectable change and difference.

Results

ICCs were 0.93 for PR interval, 0.78 for P axis, 0.77 for maximum P area, and 0.58 for maximum P duration. Within- and between-visit Kappa were 0.30 and 0.11 for P dispersion, and 0.68 and 0.46 for P terminal force.

Conclusion

Repeatability of PR duration was excellent, that of P wave axis and maximum area was fair, and maximum P wave duration and terminal force was poor. Repeatability of P wave dispersion was fair within visit, yet poor between visits. These results illustrate potential biases when measurement error of some P wave indices is ignored in clinical and epidemiologic studies.     

PR间期与二尖瓣返流和左心室充盈的关系

目的 探讨异常PR间期对舒张期和收缩期二尖瓣返流的影响及对左心室充盈的影响。方法 选择心房心室分离患者为模型，采用数字化超声心动图技术观察PR间期与二尖瓣返流及左心室舒张期前向血流充盈时间的关系。结果 PR延长达一定程度将引起二尖瓣舒张期返流，本例患者PR间期临界宽度为0．27S；在一定范围内PR越长则二尖瓣舒张期返流持续时间越长；PR越长，舒张期前向血流充盈时间越短。结论 PR延长是形成二尖瓣舒张期返流的重要条件；同时，PR延长使左心室充盈时间显著缩短。     

动态心电图PR间期不固定揭示房室结双径路心电图分析

目的：探讨动态心电图PR间期不固定揭示房室结双径路心电图改变。方法对44例动态心电图PR间期不固定患者进行回顾性分析。结果不典型二度房室阻滞莫氏I型现象揭示房室结双径路的发生率最高，以心动过缓及夜间为主，室性早搏次之。结论慢径路传导所致的过度延长PR间期影响心脏的电和机械活动匹配或房室同步，长时间将导致患者心功能不全，动态心电图报告需加以强调。     

Risk of development of delayed atrioventricular block after slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval.

AIMS: The objective of this prospective study was to assess risk factors for the development of atrioventricular block following slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a pre-existing prolonged PR interval. METHODS AND RESULTS: Of 346 consecutive patients with atrioventricular nodal reentrant tachycardia undergoing slow pathway modification, 18 patients (62 +/- 7 years; five females) were found to have a prolonged PR interval prior to ablation. Total elimination of the functional slow pathway was assumed if the antegrade effective refractory period following slow pathway modification was longer than the cycle length of atrioventricular nodal reentrant tachycardia. To detect atrioventricular node conduction disturbances, 24-h Holter recordings were performed 1 day prior to slow pathway modification, and 1 day, 1 week, 1, 3 and 6 months after the procedure. Six patients developed late atrioventricular block. The incidence of delayed atrioventricular block following successful slow pathway modification was higher in patients with, compared to patients without, prolonged PR interval at baseline (6/18 vs 0/328, P < .001). In the former group, the antegrade effective refractory period was longer in patients with, compared to those without, a delayed atrioventricular block (492 +/- 150 ms vs 332 +/- 101 ms, P < 0.05). The incidence of delayed atrioventricular block was higher in patients with total elimination of the slow pathway compared to patients without (5/7 vs 1/11, P < 0.01). CONCLUSIONS: Slow pathway modification in patients with atrioventricular nodal reentrant tachycardia and a prolonged PR interval is highly effective. However, there is a significant risk of development of delayed atrioventricular block, particularly when the procedure results in total elimination of the slow pathway.     

PR interval prolongation is significantly associated with aortic root abscess: An age- and gender-matched study

Background

Electrocardiographic abnormalities, such as PR interval prolongation, have been anecdotally reported in patients with aortic root abscess (ARA). An electrocardiographic marker may be useful in identifying those patients with aortic valve endocarditis who may progress to ARA. The objective of this study is to evaluate the change in the PR interval in patients with surgically confirmed ARA and compare it to age- and gender-matched controls with echocardiographically or surgically confirmed aortic valve endocarditis but without aortic root abscess and those hospitalized with diagnoses other than endocarditis.

Methods

Patients were eligible for enrollment if they were 18 years or older and were hospitalized for either ARA, aortic valve endocarditis, or for unrelated reasons and had at least one 12-lead electrocardiogram (ECG) prior to or on the day of hospitalization and at least one ECG after hospitalization but prior to any cardiac surgical procedure. Delta PR interval, defined as the difference between the pre- and post-admission PR interval, was the primary outcome of interest. The patients in the ARA group were age- and gender-matched to patients with aortic valve endocarditis and to those without endocarditis. Comparisons of demographic variables and study outcomes were performed.

Results

Eighteen patients with surgically confirmed ARA were enrolled. These patients were age- and gender-matched to 19 patients with aortic valve endocarditis and 18 patients with no past history or evidence of endocarditis during hospitalization. No difference was noted in the baseline PR interval between the groups. However, the PR interval following admission in the aortic root abscess group (201 ± 66 ms) was significantly longer than the PR interval in both the aortic valve endocarditis (162 ± 27 ms) (24%, p = .009) and no endocarditis (143 ± 24 ms) (40%, p < .001) groups. The primary outcome measure, delta PR interval, was significantly longer in the ARA group (35 ± 51 ms) than no endocarditis (−5 ± 17 ms) (p = .001) and aortic valve endocarditis groups (0.2 ± 18) (p = .003).

Conclusions

The findings of our study support the notion that the PR interval is more likely to be prolonged in patients with ARA. Since ARA is associated with a high morbidity and mortality, PR interval prolongation in a patient with aortic valve endocarditis should prompt a thorough evaluation for aortic root involvement.

     

Value of frontal QRS axis for risk stratification of individuals with prolonged PR interval

Background

There is ongoing controversy regarding the prognostic value of PR prolongation among individuals free of cardiovascular diseases. It is necessary to risk-stratify this population according to other electrocardiographic parameters.

Methods

This study is based on the Third National Health and Nutrition Examination Survey. Cox proportional hazard models were constructed and Kaplan–Meier method was used.

Results

A total of 6188 participants (58.1 ± 13.1 years; 55% women) were included. The median frontal QRS axis of the entire study population was 37° (IQR: 11–60°). PR prolongation was present in 7.6% of the participants, of whom 61.2% had QRS axis ≤37°. In a multivariable-adjusted model, mortality risk was highest in the group with concomitant prolonged PR interval and QRS axis ≤37° (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.04–1.39). In models with similar adjustment where population were reclassified depending on PR prolongation and QRS axis, prolonged PR interval and QRS axis ≤37° was still associated with increased risk of mortality (HR: 1.18; 95% CI: 1.03–1.36) compared with normal PR interval.

Conclusions

QRS axis is an important factor for risk stratification in population with PR prolongation. The extent to which this population with PR prolongation and QRS axis ≤37° is at higher risk of death compared with the population without PR prolongation.     

导管射频消融对QT、JT离散度的影响

目的研究导管射频消融术（ＲＦＣＡ）对ＱＴ、ＪＴ离散度（ＱＴｄ、ＪＴｄ）的影响。方法测量６２例阵发性室上性心动过速和４例特发性室速患者ＲＦＣＡ术前、术后的ＱＴｄ、ＪＴｄ。结果所有患者术前、术后ＱＴｄ、ＪＴｄ无显著差异（Ｐ均＞０．０５），三组不同电生理机制的室上速患者之间术后ＱＴｄ、ＪＴｄ差异无显著性（Ｐ均＞０．０５）。结论ＰＦＣＡ不影响正常心室肌复极离散度。     

短QT间期的心电图诊断标准探讨

目的用2种已报道的诊断标准研究一组心电图短QT间期者所占比例,并比较2种方法的异同。方法随机选取547例健康人,做常规12导联心电图,准确测量QT间期,根据RR间期(RR)和心率(HR)计算QT间期校正值(QTc)和QT间期预计值(QTp),以QT相似文献