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患者男,51岁。因心悸约20min就诊。心电图(附图A)示:R-R匀齐,心室率167次/min,QRS时间为0.12s,Ⅰ导联呈rS型,S波粗钝增宽,Ⅱ导联呈Rs型,s波似逆行P波,V_1导联呈rsR＇型。心电图诊断:阵发性室上性心动过速,完全性右束支传导阻滞。给予三磷酸腺苷(ATP)10mg快速静脉注射并即刻连续描记心电图(附图B)Ⅱ导联。第1行R-R长短交替,短者为0.28s,长者为0.45—0.47s,S波也随R-R改变而交替变化。5s后心动过速终止,出现窦性P波,P波频率100—115次/min,P-R由0.16s逐渐延长至0.23s(第2行)后,P-R间期突然增加至0.42—0.46s,并出现2:1莫氏Ⅱ型和三度房室传导阻滞,室上性心动过速终止后V_1导联仍呈rsR＇型。心电图诊断:窦性心动过速,功能性2:1莫氏Ⅱ型和三度房室传导阻滞,完全性右束支传导阻滞,房室结双径路,R-R间期长短交替现象。
Patient male, 51 years old. Due to palpitations about 20min treatment. ECG (Figure A) shows: RR uniform, ventricular rate of 167 times / min, QRS time was 0.12s, Ⅰ lead was rS type, S wave thicker and wider, Ⅱ lead was Rs type, s wave like retrograde P wave, V_1 lead rsR ’type. ECG diagnosis: paroxysmal supraventricular tachycardia, complete right bundle branch block. A 10 mg bolus of adenosine triphosphate (ATP) was given to the venous catheter for immediate intravenous infusion (Figure B). In the first row, the length of R-R alternates, the short is 0.28s, the elderly is 0.45-0.47s, and the S-waves alternate with R-R. After 5s, the tachycardia terminated, sinus P wave appeared, the frequency of P wave was 100-115 beats / min and PR gradually increased from 0.16s to 0.23s (line 2). The PR interval suddenly increased to 0.42-0.46s, And appeared 2: 1 Mohs Ⅱ and third degree atrioventricular block, V_1 after the termination of supraventricular tachycardia still rsR ’type. ECG diagnosis: sinus tachycardia, functional 2: 1 Morse Ⅱ and third degree atrioventricular block, complete right bundle branch block, atrioventricular node dual pathway, R-R interval alternating short and long.