Kobza Richard, Hindricks Gerhard, Tanner Hildegard, Piorkowski Christopher, Wetzel Ulrike, Schirdewahn Petra, Dorszewski Anja, Gerds-Li Jin-Hong, Kottkamp Hans
Department of Electrophysiology, University of Leipzig, Heart Center, Cardiology, Leipzig, Germany.
J Interv Card Electrophysiol. 2005 Jan;12(1):55-60. doi: 10.1007/s10840-005-5841-2.
In 1999 the consensus statement "living anatomy of the atrioventricular junctions" was published. With that new nomenclature the former posteroseptal accessory pathway (APs) are termed paraseptal APs. The aim of this study was to identify ECG features of manifest APs located in this complex paraseptal space.
ECG characteristics of all patients who underwent radiofrequency ablation of an AP during a 3 year period were analyzed. Of the 239 patients with one or more APs, 30 patients had a paraseptal AP with preexcitation. Compared to APs within the coronary sinus (CS) or the middle cardiac vein (MCV) the right sided paraseptal APs significantly more often showed an isoelectric delta wave in lead II and/or a negative delta wave in aVR. The left sided paraseptal APs presented a negative delta wave in II significantly more often compared to the right sided APs.
According to the site of radiofrequency ablation, paraseptal APs are classified into 4 subgroups: paraseptal right, paraseptal left, inside the CS or inside the MCV. Subtle differences in preexcitation patterns of the delta wave as well as of the QRS complex exist. However, the definitive localization of APs remains reserved to the periinterventional intracardiac electrogram analysis.
1999年发表了“房室交界区的活体解剖”共识声明。采用这一新的命名法，以前的后间隔旁路（APs）被称为间隔旁APs。本研究的目的是确定位于这一复杂间隔旁区域的显性APs的心电图特征。
分析了3年内所有接受APs射频消融治疗患者的心电图特征。在239例有一个或多个APs的患者中，30例有间隔旁APs伴预激。与冠状窦（CS）或心中静脉（MCV）内的APs相比，右侧间隔旁APs在II导联更常出现等电位δ波和/或在aVR导联出现负向δ波。与右侧APs相比，左侧间隔旁APs在II导联出现负向δ波的频率明显更高。
根据射频消融部位，间隔旁APs分为4个亚组：右侧间隔旁、左侧间隔旁、CS内或MCV内。δ波以及QRS波群的预激模式存在细微差异。然而，APs的确切定位仍需依靠介入期间的心内电图分析。
