Zhao xiaoping, Zhu zhengyan, Cao guanhong, et al. Analysis of electrocardiographic phenomena of dual atrioventricular nodal pathways revealed by dynamic electrocardiogram[J]. 2021, 30(1): 23-28.
Zhao xiaoping, Zhu zhengyan, Cao guanhong, et al. Analysis of electrocardiographic phenomena of dual atrioventricular nodal pathways revealed by dynamic electrocardiogram[J]. 2021, 30(1): 23-28.DOI:
Objective To investigate the changes of electrocardiogram(ECG) in dual pathway conduction of atrioventricular node(AVN) revealed by dynamic electrocardiogram(DCG). Methods The ECG characteristics and special ECG phenomena of 11 patients with dual atrioventricular node pathway diagnosed by dynamic ECG were retrospectively analyzed. Results In all the 11 patients
PR interval jumping prolongation occurred in dynamic electrocardiogram
and 4 of them showed two characteristic ECG phenomena which revealed the existence of dual atrioventricular node pathways.(1)Premature atrial beats revealed double atrioventricular nodal pathways in 7 cases.There were 6 cases of slow-fast atrioventricular nodal reflex tachycardia(AVNRT) induced by prolonged PR interval of atrial premature beats(two of them had single slow-fast atrioventricular nodal reflex
i.e. atrial echo appeared after prolonged PR interval of atrial premature beats); atrial premature beats prolonged PR interval of atrial premature beats and lasted several beats. There was one case of downward transmission of pathways(another ECG phenomenon was also present in this case: fixed PR interval of length and spontaneous transition of conduction between fast and slow pathways);(2) Atypical Ventricular Blockade(AVB)
PR Interval Jumping Extension and PR Interval Jumping Extension followed by slow pathway downward transmission
and slow pathway forward transmission was terminated in1 case by blocked downward P wave;(3) Atypical ventricular block with Wenckebach cycle
and there was one patient’s Wenckebach cycle ended with an atrial echo;(4)Second degree 2:1 atrioventricular block
two fixed PR intervals between long and short phases
fast-slow pathway conduction after downward blocked P-wave in 1 case;(5)The PR interval jumping type was prolonged excessively after the insertion of premature ventricular beats
and the phenomenon of slow pathway downward transmission was associated with atypical antiventricular conduction in 1 case. Conclusions Jumping prolongation of PR interval is an indispensable feature of dual atrioventricular nodal pathways. Understanding these characteristic ECG phenomena is helpful to diagnose dual atrioventricular nodal pathway conduction by surface ECG and reduce misdiagnosis.