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急性冠状动脉综合征合并巨大顿挫型J波时出现的短暂性左间隔分支阻滞。

Transient left septal fascicular block in the setting of acute coronary syndrome associated with giant slurring variant J-wave.

作者信息

Pérez-Riera Andrés Ricardo, Barbosa-Barros Raimundo, Lima Aragão Wallam, Daminello-Raimundo Rodrigo, de Abreu Luiz Carlos, Tonussi Mendes Rossette do Valle Joseane Elza, Esposito Sorpreso Isabel Cristina, Nikus Kjell

机构信息

Design of Studies and Scientific Writing Laboratory in the ABC School of Medicine, Santo André, São Paulo, Brazil.

Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Brazil.

出版信息

Ann Noninvasive Electrocardiol. 2018 Nov;23(6):e12536. doi: 10.1111/anec.12536. Epub 2018 Feb 24.

DOI:10.1111/anec.12536
PMID:29476573
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6931563/
Abstract

We report a case of acute coronary syndrome with transient prominent anterior QRS forces (PAF) caused by proximal subocclusion of the left anterior descending (LAD) coronary artery before the first septal perforator branch. The ECG change indicates left septal fascicular block (LSFB) with associated slurring-type giant J-wave. Currently, this J-wave variant is considered as a lambda-like wave or QRS-ST-T "triangulation". Its presence is indicative of poor prognosis because of the risk for cardiac arrest as a consequence of ventricular tachycardia/ventricular fibrillation (VT/VF).

摘要

我们报告一例急性冠状动脉综合征，其在第一间隔穿支分支之前由左前降支（LAD）冠状动脉近端次全闭塞引起短暂突出的前向QRS波力（PAF）。心电图改变提示左间隔分支阻滞（LSFB）伴相关的模糊型巨大J波。目前，这种J波变异被认为是λ样波或QRS-ST-T“三角化”。由于室性心动过速/心室颤动（VT/VF）导致心脏骤停的风险，其存在提示预后不良。

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本文引用的文献

1
Transient left septal and anterior fascicular block associated with type 1 electrocardiographic Brugada pattern.与1型心电图Brugada模式相关的短暂性左间隔和前分支阻滞。
J Electrocardiol. 2018 Jan-Feb;51(1):145-149. doi: 10.1016/j.jelectrocard.2017.07.015. Epub 2017 Jul 25.
2
R-Peak Time: An Electrocardiographic Parameter with Multiple Clinical Applications.R波峰时间：一种具有多种临床应用的心电图参数。
Ann Noninvasive Electrocardiol. 2016 Jan;21(1):10-9. doi: 10.1111/anec.12323. Epub 2015 Nov 2.
3
QRS-ST-T triangulation with repolarization shortening as a precursor of sustained ventricular tachycardia during acute myocardial ischemia.急性心肌缺血期间，以复极缩短为持续性室性心动过速先兆的QRS-ST-T三角测量法
J Arrhythm. 2015 Apr;31(2):118-20. doi: 10.1016/j.joa.2014.08.006. Epub 2014 Sep 20.
4
Characteristics of electrocardiographic repolarization in acute myocardial infarction complicated by ventricular fibrillation.急性心肌梗死合并心室颤动时心电图复极的特征
J Electrocardiol. 2012 May-Jun;45(3):252-9. doi: 10.1016/j.jelectrocard.2011.11.007. Epub 2012 Jan 10.
5
Long-term outcome associated with early repolarization on electrocardiography.心电图早期复极与长期预后的关系。
N Engl J Med. 2009 Dec 24;361(26):2529-37. doi: 10.1056/NEJMoa0907589. Epub 2009 Nov 16.
6
Lambda-like ST segment elevation in acute myocardial infarction - a new risk marker for ventricular fibrillation? Three case reports.急性心肌梗死中类似λ波的ST段抬高——心室颤动的新风险标志物？三例病例报告。
Kardiol Pol. 2008 Aug;66(8):873-7; discussion 877-8.
7
Wellens syndrome associated with prominent anterior QRS forces: an expression of left septal fascicular block?伴有显著前向QRS波群力的Wellens综合征：左间隔束支传导阻滞的一种表现？
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8
Augmentation of J waves and electrical storms in patients with early repolarization.早期复极患者J波增大与电风暴
N Engl J Med. 2008 May 8;358(19):2078-9. doi: 10.1056/NEJMc0708182.
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Sudden cardiac arrest associated with early repolarization.与早期复极相关的心脏骤停
N Engl J Med. 2008 May 8;358(19):2016-23. doi: 10.1056/NEJMoa071968.
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Electrocardiographic "lambda" wave and primary idiopathic cardiac asystole: a new clinical syndrome?心电图“λ”波与原发性特发性心搏停止：一种新的临床综合征？
J Electrocardiol. 2004 Apr;37(2):105-7. doi: 10.1016/j.jelectrocard.2004.01.001.