我们报告了一名78岁的男子,这是第一例记录的在12导联ECG上相隔400毫秒的双P波病例。这些P波在铅V1上具有不同的极性。第一个P波代表右心房侧壁的激活,后一个P波代表右心房内侧和左心房的激活。沿线颅尾记录了宽间隔的双电位,可能对应于窦性心律期间的cristaterminalis。为了发生这种情况,传导障碍必须存在于右心房上部和下部。右心房上部的传导障碍会中断从窦房结到内侧壁的兴奋,右心房下部的传导障碍将中断从右心房下部外侧向记录有碎片电位的峡部区域的兴奋传播。在该患者中,这些多个离散病变似乎构成了独特的心房电病变。
We report a 78-year-old man as the first documented
case of double P waves separated by 400 msec on 12-lead ECG. These P waves had different polarities on lead V1. The first P wave represented activation of the lateral wall of the right atrium, and the latter P wave represented activation of the medial right atrium and the left atrium. Widely spaced double potentials were recorded craniocaudally along the line, presumably corresponding to the crista terminalis during sinus rhythm. For this to occur, conduction disturbance has to be present both in the upper and lower right atrium. Conduction disturbance in the upper right atrium would interrupt excitation from the sinus node to the medial wall, and conduction disturbance in the lower right atrium would interrupt excitation spreading from the lower lateral right atrium to the isthmus area where fragmented potentials were recorded. These multiple discrete lesions appear to constitute a unique electrical atriopathy in this patient.