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【中英双语 | 心电图教学】35岁男性伴窄QRS波心动过速一例

2019-08-31  yp23555

English audio presented by Dr.Ethan(杜先锋)

素材来源:

JOSEPHSON AND WELLENS ECG LESSONS

https://doi.org/10.1016/j.hrthm.2019.03.018

Let's enjoy the English learning

in the EP world

病 例 简 介  Brief introduction

图1心电图来自1名有“活动时发作快速心率”病史的35岁男性。患者因足球比赛时发作心动过速至医院就诊。

The electrocardiogram in Figure 1 is from a 35-year-old man with a history of episodes of rapid heart rhythm during exercise.He came to the hospital after a tachycardia started during a soccer match.

1心动过速时的12导联心电图:心率160次/分,QRS波时限90ms及室房分离。QRS波形态和额面电轴提示左前分支室速。窦性P波下传的正常QRS-T形态提示心动过速为特发性

Figure 1:Twelve-lead electrocardiogram of a tachycardia, at a rate of 160 beats/min, with a QRS width of 90 ms and atrioventricular dissociation. The QRS configuration and frontal plane axis suggest a left anterior fascicular tachycardia. The conducted normal QRS-T complex after the sinus P wave indicates that the tachycardia is idiopathic.

提  问 
Questions 

1、图1A中心动过速的类型是什么?

1、What kind of tachycardia is present in Figure 1?

2、你会如何终止这类心律失常,接下来又如何诊治

2、How will you terminate the arrhythmia, and what will be your next steps?

讨  论  Discussions

1. 图1中,窄QRS心动过速发作时表现出QRS波与窦性P波分离。心动过速时,心率为160次/分,QRS波时限为90ms伴额面电轴向下、胸前导联R波一致正向。其中存在1个窦性P波下传至心室,表现出正常的QRS-T形态。所有上述表现(包括心动过速时QRS波的时限),提示心动过速为起源房室结以下传导系统的特发性左前分支室速。

1.  In Figure 1, episodes of a narrow QRS tachycardia are present with dissociation between QRS complexes and sinus P waves. During the tachycardia, at a rate of 160 beats/min, the QRS complex has a width of 90 ms with an inferior axis in the frontal plane and positive concordance of the R wave in the precordial leads. There is 1 sinus P wave that is conducted to the ventricle, showing a normal QRS-T complex. All these findings, including the QRS width during the tachycardia, point to an idiopathic ventricular tachycardia (VT) arising in the left anterior fascicle of the sub-atrioventricular nodal conduction system.

2. 窦性P波后的正常QRS-ST形态提示特发性分支型室速,可静推维拉帕米针,使该心动过速终止。与患者讨论导管消融的可能治疗结果并取得同意后,对该患者进行了心内电生理检查。

2.  The information of a normal QRS-ST complex after the sinus P wave indicating an idiopathic fascicular VT prompted the administration of intravenous verapamil,resulting in the termination of the tachycardia. Following a discussion with the patient about the possible curative outcome of catheter ablation and after consent, an intracardiac electrophysiology study was performed. 

图2示心内电生理检查时的表现及导管消融后窦律时QRS波形态发生的变化。A为完美的心室起搏图;B为导管消融前记录的束支电位(P);C为消融后的12导联心电图,此时窦律下的QRS波形态已较消融前发生了明显的改变。导管消融后的心电图表现为左前分支阻滞。分支型室速行导管消融后发生束支阻滞并不少见。

The different panels in Figure 2 show the findings during the intracardiac study and also a change in QRS configuration during sinus rhythmafter catheter ablation. Panel A shows a perfect ventricular pacing map, and panel B shows the recording of a fascicular prepotential electrogram (P) before catheter ablation. Panel C is the 12-lead recording after ablation, showing a sinus rhythm with a marked change in QRS configuration in comparison with the QRS configuration during sinus rhythm before ablation;the electrocardiogram now shows left anterior fascicular block after catheter ablation. Fascicular block is not uncommon after catheter ablation of a fascicular VT.

图3为另一名特发性左后分支型室速患者,导管消融后出现左后分支阻滞。近期的文章阐述了导管消融后分支阻滞的发生率和长期随访情况,及如何在心内激动标测防止阻滞的发生,尤其是特发性左后分支型室速。

Figure 3 from another patient shows left posterior fascicular block after catheter ablation of an idiopathic left posterior fascicular tachycardia. Recent articles described,especially in idiopathic left posterior fascicular VT, the incidence and long-term follow-up of fascicular block after catheter ablation and how intracardiac activation measurements can prevent them.

图2:A:心室起搏和心动过速时的QRS波形态比较。B:1个窦律和2个心动过速时心内激动标测到的束支电位(P)。RF=消融导管位置。C:窦律时,QRS波形态改变,提示导管消融后左前分支阻滞

Figure 2:A: Comparison between the ventricular pacing map and the QRS configuration during tachycardia. B: Findings on intracardiac activation mapping during 1 sinus and 2 tachycardia beats with the behavior of the fascicular prepotential electrogram (P). RF 5 radiofrequency catheter location. C: During sinus rhythm, QRS configuration changes, indicating left anterior fascicular block after catheter ablation.

图3:1名特发性左后分支室速(B)的患者,窦律时正常心电图(A)和导管消融后(C)的QRS波形态明显改变,提示导管消融后发生了左后分支阻滞

Figure 3:A patient with an idiopathic left posterior fascicular tachycardia (B) with a clear change in QRS configuration between the normal electrocardiogram during sinus rhythm before (A) and after (C) catheter ablation, indicating left posterior fascicular block after ablation.

审    校:杜先锋

编    译:傅国华

编    辑:方任远

书心剑律|心律最前沿

微信ID:HeartRhythm

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