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目的:预激综合征影响QRS终末向量,但尚未被关注。本文应用向量图对照分析预激综合征消融旁路前后QRS终末向量变化,探讨终末向量改变与旁路位置及初始向量改变的关系。方法:选择辽宁医学院附属第一医院经导管射频消融术(radiofrequency catheter ablation,RFCA)根治显性单旁路预激综合征患者30例(按旁路部位分为7组)。用卡方检验对照分析RFCA前后QRS初始向量和终末向量的变化,并分析终末向量方位改变与初始向量改变及旁路位置的关系。结果:130例患者RFCA前后对照QRS终末立体向量均有改变:仰角改变25例,水平角改变27例,两者同时改变22例,两者一致性差,Kappa检验无统计学意义(κ=-0.379,P=0.106)。2终末向量改变与旁路位置关系:左室旁路:11/16例表现为水平角绝对值增大。其中左前壁和左侧壁旁路多表现为仰角减小;而左后壁旁路表现为仰角增大。右室旁路:10/14例患者表现为水平角绝对值减小;仰角13/14例增大。终末向量改变与初始向量改变的符合率为91.65%(κ=0.856,P=0.000)。结论:1预激综合征旁路前传不仅影响初始向量同时影响终末向量,终末向量改变与旁路位置和初始向量有关。2立体心电向量分析预激综合征初始向量、终末向量改变优于心电图,有助于心电图表现不典型的预激综合征诊断和旁路位置分析。
PURPOSE: The WPW syndrome affects QRS terminal vectors but has not been noticed. In this paper, vector diagram was used to analyze the change of QRS terminal vector before and after ablation bypass of Wolff-Parkinson-White syndrome, so as to discuss the relationship between the change of terminal vector and the position of bypass and the change of initial vector. Methods: Thirty patients (divided into 7 groups according to the bypass site) were treated by radiofrequency catheter ablation (RFCA) at the First Affiliated Hospital of Liaoning Medical College. The chi-squared test was used to analyze the QRS initial and final vector changes before and after RFCA, and the relationship between the final vector orientation change and the initial vector change and bypass position was analyzed. Results: There were changes of QRS terminal stereoscopic vector in RFCA before and after RFCA in 130 patients: elevation angle changed in 25 cases, horizontal angle changed in 27 cases, and both changed in 22 cases at the same time. The consistency between them was poor and Kappa test was not statistically significant (κ = 0.379, P = 0.106). 2 terminal vector changes and the bypass position relationship: left ventricular bypass: 11/16 cases showed an increase of the horizontal angle absolute value. The left anterior wall and the left side of the bypass showed more elevation angle; while the left posterior wall bypass showed an elevation angle. Right ventricular bypass: 10/14 patients showed a decrease in the absolute value of horizontal angle; elevation 13/14 cases increased. The coincidence rate of terminal vector change and initial vector change was 91.65% (κ = 0.856, P = 0.000). Conclusion: Pre-excitation syndrome bypass pre-transmission not only affects the initial vector at the same time affect the terminal vector, the terminal vector changes with the bypass position and the initial vector. 2 Stereotaxic vector analysis of the initial vector of Wolff-Parkinson’s syndrome, terminal vector changes better than electrocardiogram, contribute to the diagnosis of ECG with atypical pre-excitation syndrome and bypass location analysis.