预激综合征射频消融术后心电图电张调整性T波及J-ST段特征分析

目的探讨预激综合征射频消融房室旁道后心电图出现电张调整性T波及J-ST段的特征及其发生机制。方法45例持续性预激综合征患者,对比射频消融术前后心电图,总结和分析术后电张调整性T波、J波以及ST段变化的发生规律和特征。结果45例中射频消融术后出现电张调整性T波改变有27例,间隔部和左前壁旁道消融后电张调整性T波出现率最高(达100%),电张调整性T波主要分布于下壁导联(Ⅱ、Ⅲ、aVF)和高侧壁导联(Ⅰ、aVL);下壁导联电张调整性T波倒置深度Ⅲ>aVF>Ⅱ(P<0.01),高侧壁导联aVL>Ⅰ。此外尚可出现J-ST改变,表现为J点抬高、J波和ST段水平或弓背向下型抬高,总发生率高于同期隐匿性旁道消融组(42.2%vs3.5%,P<0.01)。结论预激综合征射频消融术后电张调整性T波的出现取决于预激时QRS波形态;射频消融术后心电图可出现类似早期复极综合征的J-ST段改变。

Characteristics of electrotonic modulated T wave and J-ST segment after radiofrequency ablation in patients of preexcitation syndrome

Objective To investigate characteristics of electrotonic modulated T wave and the J-ST segment in ECG in patients with preexcitation syndrome after radiofrequency ablation(RFCA).Method Characteristics of electrotonic modulated T wave and the J-ST segment in ECG were analyzed before and after RFCA in 45 cases who had preexcitation syndrome.Results ①Electrotonic modulated T wave was detected in 27 of the 45 cases(60%),all cases(15 cases,100%)with accessory pathway(AP) in septum or left anterior free wall presented modulated T wave after successful ablation;②In spite of the location of AP,electrotonic modulated T wave was mainly found in inferior wall leads(Ⅱ,Ⅲ,and aVF)and high lateral wall leads(Ⅰ,aVL).Amplitude of electrotonic modulated T wave was Ⅲ>aVF>Ⅱ(P<0.01) in inferior wall leads and aVL>Ⅰin high lateral wall leads.③After ablation,elevation of J point,J wave and ST segment could be found in ECG,this characteristics were significantly higher in preexcitation syndrome group than in the recessive AP group(42.2% vs 3.5%,P<0.01).Conclusions Appearance of electrotonic modulated T wave in ECG after RFCA depends on the location of AP which results in different QRS complex.Furthermore,changs of J-ST segment is similar to early repolarization syndrome.