CAJ | 학술논문

目的：探讨食管心房调搏宽QRS波与隐性心室预激的相关性。方法将77例行食管心房调搏检查（TEAP）的患者根据心电图结果不同分为两组，Ⅰ组45例患者心电图正常，经心内电生理检查（EPS）排除存在隐性心室预激；Ⅱ组32例患者心电图显性心室预激，并经EPS证实。Ⅰ组患者TEAP显示电脉冲波（ S波）后间断或连续呈宽 QRS 波群图形，并测量 SR 间期，同时与Ⅱ组患者的 TEAP 进行对比分析。结果（1）Ⅰ组患者中20例（ⅠA组）为心室起搏，TEAP究其图形显示S波后紧随宽大QRS波群呈右束支阻滞图形，SR为0 s；25例（ⅠB组）SR间期不固定，SR为（0．07±0．01）s，S波与QRS波无关，为室性期前收缩，QRS波群形态据期前收缩起源点不同而不同。（2）Ⅱ组患者TEAP检查过程中S波后有紧密相关的心房除极P波，经过较正常缩短的房室传导时间后出现起始有预激波的宽大 QRS波群，SR间期固定，SR为（0．08±0.03）s，同时不同部位旁道QRS波群有不同形态特征。（3）ⅠA组与ⅠB组、Ⅱ组SR间期差异有统计学意义（t＝2．97、3．02，均P＜0．05）；而ⅠB组与Ⅱ组SR间期差异无统计学意义（t＝2．66，P＞0．05）。结论当食管心房调搏检查起搏宽QRS波群时，应综合分析，不应盲目认为是隐性预激旁道，避免给患者带来误诊治。
목적：탐토식관심방조박관QRS파여은성심실예격적상관성。방법장77례행식관심방조박검사（TEAP）적환자근거심전도결과불동분위량조，Ⅰ조45례환자심전도정상，경심내전생리검사（EPS）배제존재은성심실예격；Ⅱ조32례환자심전도현성심실예격，병경EPS증실。Ⅰ조환자TEAP현시전맥충파（ S파）후간단혹련속정관 QRS 파군도형，병측량 SR 간기，동시여Ⅱ조환자적 TEAP 진행대비분석。결과（1）Ⅰ조환자중20례（ⅠA조）위심실기박，TEAP구기도형현시S파후긴수관대QRS파군정우속지조체도형，SR위0 s；25례（ⅠB조）SR간기불고정，SR위（0．07±0．01）s，S파여QRS파무관，위실성기전수축，QRS파군형태거기전수축기원점불동이불동。（2）Ⅱ조환자TEAP검사과정중S파후유긴밀상관적심방제겁P파，경과교정상축단적방실전도시간후출현기시유예격파적관대 QRS파군，SR간기고정，SR위（0．08±0.03）s，동시불동부위방도QRS파군유불동형태특정。（3）ⅠA조여ⅠB조、Ⅱ조SR간기차이유통계학의의（t＝2．97、3．02，균P＜0．05）；이ⅠB조여Ⅱ조SR간기차이무통계학의의（t＝2．66，P＞0．05）。결론당식관심방조박검사기박관QRS파군시，응종합분석，불응맹목인위시은성예격방도，피면급환자대래오진치。
Objective To explore the correlation between wide QRS of transesophageal atrial pacing (TEAP) and implicit ventricular pre-excitation.Methods 77 patients tested by TEAP were divided into two groups according to the ECG results .45 patients in group Ⅰhad normal electrocardiogram .32 patients in group Ⅱhad ven-tricular pre-excitation.In group Ⅰ,TEAP results showed that electric pulse wave (S wave) was followed by intermit-tent or continuous wide QRS complex .At the same time , the results of group Ⅰ were compared with the results of groupⅡ.Results (1)The patients of group Ⅰwere excluded the presence of concealed accessory pathway by intra-cavitary electrocardiographic test,among them 20 patients (group ⅠA) were ventricular pacing,the test results dis-played that S wave was followed by wide QRS complex exhibiting a pattern of right bundle branch block ( RBBB) ,SR interval was 0 s;SR intervals of 25 patients (groupⅠB) were not fixed,SR interval was (0.07 ±0.01)s,S wave had no concern with QRS wave ,the wide QRS complex was premature ventricular contraction ,QRS wave shapes were dif-ferent according to the different sites of pacing origin .(2)In groupⅡ,the test results displayed that S wave was close-ly followed by the atrial depolarization wave P ,and there was a wide QRS complex with pre-excitation wave at the be-ginning after a atrioventricular conduction time shorter than normal ,SR interval was fixed ,SR interval was (0.08 ±0. 03)s,at the same time,different parts of accessory pathway QRS complex had different morphological characteristics . (3) SR interval of ⅠA group compared with groupⅠB and groupⅡ,the differences were statistically significant ( t=2.97,3.02,all P<0.05);SR interval had no statistically significant difference between group ⅠB and groupⅡ(t=2.66,P>0.05).Conclusion When TEAP displaying pacing wide QRS complex ,in order to avoid bringing misdiag-nosis,TEAP results should be analyzed comprehensively rather than blindly believing that the reason was concealed accessory pathway .