房室旁道的传导特性：旁道位置及正常房室传导的重要性

Conduction properties of accessory atrioventricular pathways: importance of the accessory pathway location and normal atrioventricular conduction.

作者信息

Liu Shaowen, Yuan Shiwen, Olsson S Bertil

机构信息

Department of Cardiology, University Hospital, Lund University, SE-221 85 Lund, Sweden.

出版信息

Scand Cardiovasc J. 2003;37(1):43-8. doi: 10.1080/14017430310007027.

DOI:10.1080/14017430310007027

PMID:12745802

Abstract

OBJECTIVE

The objective of this study was to determine the conduction properties of the normal atrioventricular (AV) conduction system in relation to accessory pathway (AP) location in patients with symptomatic Wolff-Parkinson-White syndrome.

DESIGN

The conduction properties of the AP and the AV node were studied in 356 patients with single manifest AP who underwent successful ablation.

RESULTS

Sixty-three percent of the APs were located on the left free wall (226) and the remaining 37% were posteroseptal, anteroseptal and right free wall. AV block (PR > or =220 ms) was observed in 15 patients, 8 cases being associated with the right free wall (15%) compared with 7 on the left free wall (3%, p = 0.002) and none on the anteroseptal (p = 0.02) or posteroseptal (p = 0.007). The PR (182 +/- 30 ms) and AH (102 +/- 25 ms) intervals associated with right free wall AP were longer than left free wall (166 +/- 23, 88 +/- 21 ms, p < 0.0001, respectively), anteroseptal (155 +/- 11, 79 +/- 12 ms, p < 0.0001) and posteroseptal AP (155 +/- 16, 79 +/- 13 ms, p < 0.0001), whereas the PR and AH intervals associated with posteroseptal and anteroseptal AP were shorter than left free wall AP (p < 0.05). When patients with AV block were excluded from the analysis, the PR intervals in patients with right free wall AP were still longer than in those with left free wall (p < 0.005), anteroseptal (p < 0.001) and posteroseptal AP (p < 0.0001), as were the PR intervals associated with left free wall AP compared with data of posteroseptal (p < 0.01) and anteroseptal AP (p < 0.05). Significant differences in AV nodal effective refractory period, anterograde and retrograde AV block cycle length were also observed in relation to AP location.

CONCLUSION

The conduction properties of the normal AV conduction system are associated with specific AP location in patients with Wolff-Parkinson-White syndrome.

摘要

目的

本研究的目的是确定有症状的预激综合征患者中，正常房室（AV）传导系统的传导特性与旁路（AP）位置的关系。

设计

对356例成功接受消融治疗的单显性AP患者的AP和房室结传导特性进行了研究。

结果

63%的AP位于左游离壁（226例），其余37%位于后间隔、前间隔和右游离壁。15例患者出现房室传导阻滞（PR≥220 ms），其中8例与右游离壁相关（15%），左游离壁7例（3%，p = 0.002），前间隔（p = 0.02）或后间隔（p = 0.007）均无。与右游离壁AP相关的PR（182±30 ms）和AH（102±25 ms）间期长于左游离壁（166±23、88±21 ms，p均<0.0001）、前间隔（155±11、79±12 ms，p<0.0001）和后间隔AP（155±16、79±13 ms，p<0.0001），而与后间隔和前间隔AP相关的PR和AH间期短于左游离壁AP（p<0.05）。当排除房室传导阻滞患者进行分析时，右游离壁AP患者的PR间期仍长于左游离壁（p<0.005）、前间隔（p<0.001）和后间隔AP（p<0.0001），与后间隔（p<0.01）和前间隔AP（p<0.05）相比，左游离壁AP相关的PR间期也有显著差异。在房室结有效不应期、顺行和逆行房室传导阻滞周期长度方面，也观察到与AP位置相关的显著差异。