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目的通过分析预激综合征患者旁道的电生理特性以及消融旁道后P波离散度(Pd)的计算,探讨预激综合征发生阵发性心房颤动(简称房颤)的机制。方法分析预激综合征合并旁道介导的阵发性心动过速患者127例。根据既往有无阵发性房颤(PAF)发作将患者分为PAF组(23例)和无PAF组(NPAF,104例)2组进行分析。电生理检查测定旁道的前传和逆传不应期。消融成功术后24h描记12导联心电图测量P波最大时限(Pmax)、P波最小时限(Pmin),计算Pd。结果消融前PAF组旁道前传和逆传不应期较NPAF组短(前传:265.3±42.5msvs331.4±38.7ms;逆传:255.8±46.7msvs317.5±31.7ms;P均<0.05)。消融术后心电图Pmax和PdPAF组显著长于NPAF组(Pmax:135.2±12.5msvs120.4±8.7ms;Pd:51.6±10.3msvs32.7±6.7ms;P均<0.05)。结论旁道有效不应期缩短和窦性激动在心房内的非均质传导在预激综合征患者房颤发生中可能起重要作用。
Objective To investigate the mechanism of paroxysmal atrial fibrillation (WPF) by analyzing the electrophysiological characteristics of bypass in patients with WPW syndrome and the calculation of P wave dispersion (Pd) after bypass. Methods The analysis of 127 cases of WPW syndrome complicated with accessory pathways mediated paroxysmal tachycardia. Patients were divided into two groups: PAF group (n = 23) and non-PAF group (n = 104) according to previous episodes of paroxysmal atrial fibrillation (PAF). Electrophysiological test to determine the precession and retrograde refractory period. After successful ablation, the 12-lead electrocardiogram was used to measure the maximal P-wave and P-wave minimum P-wave amplitude 24h after the ablation. Pd was calculated. Results The pre-ablation and retrograde refractory periods in PAF group were shorter than those in NPAF group (265.3 ± 42.5 ms vs 331.4 ± 38.7 ms and 255.8 ± 46.7 ms vs 317.5 ± 31.7 ms, P <0.05, respectively). After ablation, Pmax and PdPAF groups were significantly longer than NPAF group (Pmax: 135.2 ± 12.5ms vs 120.4 ± 8.7ms; Pd: 51.6 ± 10.3msvs32.7 ± 6.7ms; P <0.05 respectively). Conclusions The effective bypass of refractory period and the non-homogeneous conduction of sinus stimulation in the atria may play an important role in the occurrence of atrial fibrillation in WPW syndrome patients.