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房室结折返激动是一种很常见的现象。倘若折返激动未引起心房回波和/或反复心室除极,则为隐匿性折返。这种现象仅能从其对下一个激动形成和/或传导的影响而推断其存在与否。本文报告1例伴文氏型房室传导阻滞的显性和隐匿性房室结折返激动。 患者男,74岁。心电图描记前未服任何心血管药物,无心脏方面主诉。图1为连续描记的Ⅱ导联心电图(图中数字表示R-R间期),具有下列5个特点:(1)基础心律为窦性,P-P间期为0.74—0.78s。(2)窦性心律呈文氏现象,如上行第3个P-R间期为0.26s,而第4个P-R间期是0.34s。(3)每个文氏周期均被心房回波(P＇波)中断,如上行2、4个QRS波群之后所出现逆行P波。P＇波出现与P-R间期之间引内在联系,即仅在较长P-R间期的窦性QRS波群之后才出现心房回波。如上行第3个P-R间期0.26s,QRS波群后无P＇波,而第4个P-R间期较长(0.34s),QRS波群后出现P＇波。(4)这些心房回波未传抵心室,但它可侵入窦房结并重整窦房结周期,导致较长间歇。这些间歇有时被交接区性逸搏所间断,并与几乎同时出现的窦性P波发生干扰。如上行最末1个,中行第3个和下行第2个QRS波群均为房室交接区性心搏并与窦性P波发生干扰现象。(5)房室交接区性逸搏周期为1.21—1.24s。然而,有几个间歇比预期还长却未按时出现交接区性逸搏
Atrioventricular nodal rejuvenation is a very common phenomenon. Occult reentry if reentry excitability does not cause atrial echo and / or repeated ventricular depolarization. This phenomenon can only be inferred from its impact on the next formation and / or conduction of excitement. This article reports a case of wen’s type atrioventricular block dominant and occult AV nodal activation. Male patient, 74 years old. No ECG before taking any cardiovascular drugs, no heart complaints. Figure 1 for the continuous tracing of the Ⅱ lead ECG (the figure shows the R-R interval), has the following five characteristics: (1) the basic rhythm of sinus, P-P interval was 0.74-0.78s. (2) The ventricular rhythms were Wen’s phenomenon, with the third P-R interval of 0.26 s in the upper line and the 0.34 s of the fourth P-R interval. (3) Each Wen’s cycle is interrupted by an atrial echo (P ’wave), such as the retrograde P wave appearing after the 2,4 QRS complex on the top. The P ’wave appears to be intrinsically linked to the P-R interval, ie an atrial echo occurs only after a sinusoidous QRS complex of longer P-R intervals. For example, the third P-R interval in the upper row is 0.26s, there is no P wave after the QRS wave group, while the fourth P-R interval is longer (0.34s) and the P wave appears after the QRS wave group. (4) These atrial echoes did not reach the ventricles, but they could invade the sinoatrial node and reorganize the sinus node cycle, resulting in a longer interval. These pauses are occasionally interrupted by vaginal delivery, and interfere with sinus P waves that appear almost simultaneously. As the last one in the uplink, the third and the second QRS complex of the BOC are all intercurrent atrioventricular wakes and interference with sinus P wave. (5) Atrioventricular junctional escape cycle of 1.21-1.24s. However, there were a few breaks that were longer than expected but did not show timely delivery of vaginal discharge