伴有胸前导联负向一致性的宽QRS波群室上性心动过速：合并埃布斯坦畸形的Mahaim旁路的心电图线索

Wide QRS complex supraventricular tachycardia with negative precordial concordance: Electrocardiographic clues for Mahaim pathway with Ebstein anomaly.

作者信息

Topaloglu Serkan, Ozeke Ozcan, Cay Serkan, Ozcan Firat, Koca Serhat, Aras Dursun

机构信息

Health Science University, Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey.

出版信息

J Electrocardiol. 2018 Jul-Aug;51(4):663-666. doi: 10.1016/j.jelectrocard.2018.04.003. Epub 2018 Apr 12.

DOI:10.1016/j.jelectrocard.2018.04.003

PMID:29997008

Abstract

Ebstein's anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation.

摘要

埃布斯坦畸形常伴有预激综合征或房室旁道型Mahaim纤维。这些旁道可引发逆向房室折返性心动过速，其中旁道作为折返环的前传支，房室结作为折返环的逆传支。由于经Mahaim纤维的逆向房室折返性心动过速通常呈左束支阻滞（LBBB）形态，因此很容易误诊为功能性LBBB的室上性心动过速，甚至误诊为室性心动过速，尤其是在存在负向一致性的情况下。一些心电图线索可能有助于避免误诊为室性心动过速以及误植入植入式心律转复除颤器（ICD）。