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患者女性,33岁,临床诊断:病毒性心肌炎。附图为1982年8月19日记录的心电图,示窦性心律。上行第2、5、8个QRS液宽大畸形,其前有窦性P波,P-R间期0.11—0.12秒,较正常QRS波的P-R间期为短,起始有δ波,为间歇性预激综合征。鉴于心房调搏时,当起搏频率达100次/分时,A-V间期不变,A-H间期延长,H-V间期由原来35毫秒缩短至25毫秒(图未刊出),结合体表心电图V_(1、2)的QRS主波向下,V_(5、6)的QRS主波向上,诊断为右侧Kent束所致的B型预激综合征。此行每3个QRS波为一组,各组中P-R间期分别为0.14、0.11和0.22秒。R-R间期依次为0.56和0.70秒,直至出现较长的间歇(0.92秒)。各组第3个心动的ST段上有一逆行P′波,R-P′为0.11秒,此系伴有心房回波的房室交界处不典型文氏现象,房室传导比例为4:3。或许该心房回波在Kent束内发生前向性隐匿传导,产生新的不应期,使接踵而来的窦性冲动只能循正常房室径路下传,故逆行P′后第一个QRS波正常。但第2—4三行中P′-P间期与上行的相等,R-P′间期也相同,其逆P′后第一个QRS波却示典型预激综合征图形。因此第1、4,7个QRS波不呈预激综合征图形显然与心房回波无关,而系旁路本身有前向性传导阻滞
Female patient, 33 years old, clinical diagnosis: viral myocarditis. The figure is recorded on August 19, 1982 ECG, showing sinus rhythm. QRS fluid up the first 2,5,8 large deformity, in front of sinus P wave, PR interval 0.11-0.12 seconds, compared with normal QRS wave PR interval is short, the beginning of δ wave, intermittent pre Irritable syndrome. In view of atrial pacing, when the pacing rate of 100 beats / min, the AV interval unchanged, the AH interval extended, the HV interval from 35 milliseconds to 25 milliseconds (not shown), combined with body surface electrocardiogram V QR (1,2) of the main wave down, V_ (5,6) QRS of the main wave up, diagnosed by the right side of the Kent beam type B WPW syndrome. Three QRS waves per row were included in this row, with P-R intervals of 0.14, 0.11, and 0.22 seconds for each group. The R-R intervals were 0.56 and 0.70 seconds, respectively, until a longer interval (0.92 seconds) occurred. There was a retrograde P ’wave on the third heartbeat ST segment in each group, with a R-P’ of 0.11 seconds. This was accompanied by an atrial echo at the atrioventricular junctional atypical Venturi phenomenon with a 4: 3 AV conduction ratio. Perhaps the atrial echo in the Kent beam occult anterior conduction occurs, resulting in a new refractory period so that the ensuing sinus impulse only through the normal atrioventricular pathway, so the retrograde P after the first QRS The wave is normal. However, in the 2-4th row, the P’-P interval is equal to the upstream, and the R-P ’interval is also the same. The first QRS wave after the inverse P’ shows the typical Wolff-Parkinson-White syndrome pattern. Therefore, the first 1,4,7 QRS wave is not pre-excitation syndrome is clearly related to the atrial echo has nothing to do, and the Department of the bypass itself has an anterior block