患者男,18岁。因胸痛3天入院。入院心电图如图1。心电图示:右束支阻滞型心动过速;心室率:206次/分,心房率:100次/分,P波跟QRS波呈1∶2关系,每个P波(箭头所示)后面可见2个QRS波(Ⅲ导联明显、图2放大的Ⅲ导联P波清晰),T波振幅忽高忽低,也提示振幅高的T波中融合有P波;P波在Ⅰ、Ⅱ、Ⅲ、a VF导联直立,在a VR导联倒置,符合窦性P波的特点。患者动态心电图心动过速终止后的窦性P波下传的QRS波正常;故心动过速时的右束支阻滞属于快频率依赖性右束支阻滞(图1)。本例患者的房室结存在不应期和传导速度均不相同的快、慢两条径路。窦性P波在一定条件下可经房室结快、慢径路分别下传,先后激动心室引起两个QRS波,这种一次窦性P紧跟两个QRS波的情况称为心电图“一拖二”心电现象。同时,慢径路存在逆向阻滞,快径路下传的激动不能再经过慢径路逆传,因而患者不会发生折返性心动过速(图2)。
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